Senior Actuary

Harbor Health

About The Position

The Senior Actuary will serve as a key resource within Harbor Health's Actuarial team, leading development, pricing, reserving, risk adjustment, and financial forecasting for individual products. This role requires deep expertise in the ACA market, including the ability to navigate the legal, regulatory, and strategic landscape with innovative plans and care models. Effective collaboration with key stakeholders in Finance, Product, Health Plan Operations, and others across the organization is critical.

Requirements

Minimum 5-10 years of actuarial experience in health insurance or managed care
Demonstrated expertise in Individual/ACA lines of business, including ACA pricing, risk adjustment, and regulatory compliance
Proficiency in actuarial and data analysis tools (Excel, SQL, Python, and other statistical and modeling software)
Strong understanding of ACA market structure, regulatory framework (APTC, CSR, risk adjustment, MLR), and CMS reporting requirements
Ability to manage multiple priorities and deliver under tight deadlines
Bachelor's degree in Actuarial Science, Mathematics, Statistics, Data Science, or a related quantitative field
Fellow of the Society of Actuaries (FSA) or Associate of the Society of Actuaries (ASA) with progression toward Fellowship
Member of the American Academy of Actuaries (MAAA) and compliant with USQS requirements for issuing Statements of Actuarial Opinion (SAOs) for ACA plans
Analytical rigor and attention to detail
Clear written and verbal communication skills
Intellectual curiosity and continuous learning mindset
Collaborative approach across cross-functional teams
Ability to operate independently in a fast-paced, growth-oriented environment

Nice To Haves

Experience at an integrated payvider, health plan, or managed care organization
Experience with Small Group and Level Funded products

Responsibilities

Develop, maintain, and refine actuarial pricing models for Individual/ACA and other health plan lines of business, including rate filings
Analyze claims experience, utilization patterns, demographic trends, and market developments to inform pricing strategy
Monitor and model the impact of federal and state legal and regulatory developments
Establish and maintain IBNR (Incurred But Not Reported) reserve estimates and loss ratio projections
Prepare monthly, quarterly, and annual actuarial accruals to support financial close processes
Provide variance analysis comparing actual results to prior projections and communicate drivers to leadership
Develop and lead risk adjustment accrual modeling and forecasting
Support ACA risk score reconciliations and RADV audits
Collaborate with Product and Benefit Design teams on benefit configuration, plan design analysis, and network adequacy modeling
Provide actuarial support for market expansion decisions, product launches, and strategic initiatives
Review public filings to understand competitor product and pricing strategies
Develop scenario analyses and sensitivity testing to quantify financial risk and opportunity
Present actuarial findings and recommendations clearly to non-actuarial audiences including Finance, Executive Leadership, and the Board
Serve as a subject matter expert on Individual/ACA market dynamics, industry trends, and emerging actuarial methods