Staff Actuary - Medicare - Health Insurance Job at EmblemHealth, New York, NY

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  • EmblemHealth
  • New York, NY

Job Description

Summary:

We are seeking a hands-on Medicare Actuary to support pricing, forecasting, and bid development for Medicare Advantage (MA), Part D, and EGWP products. This role will support end-to-end bid season execution, Medicare forecasting, and deliver deep experience analytics to inform pricing, product strategy, and financial performance. The ideal candidate combines Medicare bid expertise , experience study rigor , and a builder mindset to improve processes, and elevate insights.

Key Responsibilities:

Bid & Pricing (MA/Part D/EGWP)

  • Own actuarial components of the annual Medicare Advantage and Part D bids , including benefit pricing, trend, risk score assumptions, admin load, and margins.
  • Be a collaborative partner across teams by pricing product scenarios.
  • Review ongoing CMS releases and refine assumptions to monitor a rapidly changing landscape.

Forecasting

  • Deliver regular forecasting with clear drivers, risks, and variances vs. plan/budget.

Requirements:

  • Bachelor’s degree in Actuarial Science, Mathematics, other physical science, or related finance/business degree required
  • Associate of the Society of Actuaries (ASA) required
  • 5 – 8+ years relevant professional work experience and/or education required
  • 4+ years health insurance actuarial experience, preferably in the managed care industry required
  • Prior management experience (processes and/or staff) preferred
  • A comprehensive understanding of actuarial principles and methodologies; strong mathematical and analytical skills required
  • Ability to communicate effectively with Business leaders required
  • Expert level skills with database, spreadsheet, and analytical software required
  • Proficiency with MS Office (Word, Excel, Access, PowerPoint, Outlook, Teams, etc.) required
  • Strong data querying skills using tools such as SQL or SAS Enterprise Guide preferred
  • Capable with data extraction, simulations, automation required

Job Tags

Work experience placement

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