Job Description

Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs:

* Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women

* Children’s Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR

* Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.

* Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits with additional health benefits like dental, vision, transportation, and more.

Improving Members' experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.

Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.

Skills / Requirements

JOB SUMMARY

The Medicare Lead Actuary will lead the development and submission of Medicare Advantage bids while ensuring compliance with CMS requirements and driving strategic growth initiatives. This role combines technical actuarial expertise with leadership and strategic business partnership. In addition to bid submissions the Medicare Lead Actuary will support research and modeling for product expansion feasibility studies, research medical cost improvement opportunities, and support other ongoing and ad-hoc actuarial or analytics research.

JOB SPECIFICATIONS 

  • Lead end-to-end bid development process for Medicare Advantage products.
  • Develop and maintain bid pricing models, including trend analysis, risk score projections, and benefit design optimization.
  • Partner with Product, Sales, and Finance teams to align bid strategy with organizational goals.
  • Ensure compliance with CMS requirements and actuarial standards of practice.
  • Present bid recommendations to senior leadership and support strategic decision-making.
  • Conduct competitive analysis and market research to inform bid positioning.
  • Oversee documentation of bid assumptions, methodologies, and decisions.
  • Monitor bid performance and develop action plans for variances.
  • Improve efficiency of bid development process.
  • Improve strategic decision-making with data-driven insights.


QUALIFICATIONS:

  • Education/Specialized Training/Licensure: Bachelor's degree in mathematics, Actuarial Science, or related field required.
  • Associate of the Society of Actuaries (ASA). Fellow of the Society of Actuaries (FSA) preferred.
  • Work Experience (Years and Area): 2+ years of Medicare Advantage pricing and bid development experience.
  • 5+ years of Actuarial experience required.
  • 4+ years of Medicare Advantage pricing and bid development experience preferred. 7+ years of Actuarial experience.

Management Experience (Years and Area): N/A 2+ years of management experience.

Software Proficiencies: Excel, SQL Excel, MS SQL Server

Other:

  • Knowledge of risk adjustment methodologies
  • Experience with actuarial modeling tools and bid pricing
  • Strong analytical and problem-solving abilities.
  • Excellence in project management and meeting deadlines.
  • Outstanding communication skills with technical and non-technical audiences.
  • Ability to influence and collaborate across departments.
  • Strategic thinking and business acumen.
  • Knowledge of risk adjustment methodologies
  • Experience with actuarial modeling tools and bid pricing
  • Strong analytical and problem-solving abilities.
  • Excellence in project management and meeting deadlines.
  • Outstanding communication skills with technical and non-technical audiences.
  • Ability to influence and collaborate across departments.
  • Strategic thinking and business acumen.


Reports to Position Title: Actuarial Director

COMPETENCIES

  • Analytical Thinking
  • Motivated
  • Results Oriented
  • Taking Initiative

Application Instructions

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