WelbeHealth PACE (Program of All-Inclusive Care for the Elderly) helps seniors stay in their homes and communities by providing all-inclusive medical care and community-based services. We serve our most vulnerable seniors with better quality and compassion in a value-based model.
The Director, Actuary is accountable for all actuarial functions related to PACE revenue, claims modeling, and financial analysis. This role will focus on overseeing capitation rates, risk adjustment methodologies, claims forecasting, and Incurred But Not Reported (IBNR) reserves to guide the organization’s strategic decision-making.
Essential Job Duties:
- Direct the development, maintenance, and enhancement of the PACE revenue model, ensuring accurate accounting, forecasting, and financial planning
- Assess and refine risk-adjusted revenue projections for Medicare-Medicaid dual-eligible populations, incorporating CMS and state methodologies
- Own and enhance methodologies for claims projection, IBNR estimation, and actuarial reserve setting to ensure financial stability and regulatory compliance
- Monitor and interpret CMS, state, and Medicaid regulatory changes impacting reimbursement rates, risk scores, and capitation structures
- Oversee actuarial modeling, claims analyses, and risk assessments to improve cost-effectiveness and reimbursement accuracy
- Work closely with finance, underwriting, product development, and executive leadership to drive strategic initiatives
- Lead full scale actuarial projects and project teams, as well as participate in any required Quality Improvement activities, staff trainings, and meetings
Job Requirements:
- Bachelor's degree in actuarial science, mathematics, statistics, finance, or a related field required; ASA or FSA designation preferred
- Minimum of seven (7) years of actuarial experience, with a strong background in Duals (Medicare-Medicaid) or PACE revenue models highly preferred
- Two (2) years of supervisory experience with demonstrated ability managing teams and collaborating across departments to drive actuarial and financial initiatives preferred
- Excellent leadership, organizational, and communication skills in settings with seniors, their families and interdisciplinary team members
- Proficiency in actuarial software (e.g., SAS, SQL, Python, R), Excel, and financial modeling tools
- Deep understanding of CMS risk adjustment, Medicaid rate-setting, and Medicare Advantage/Part D payment models
- Must be willing and able to work a varied schedule that may include evening nights, weekends, and overtime
Benefits of Working at WelbeHealth: Apply your actuarial expertise in new ways as we rapidly expand. You will have the opportunity to design the way we work in the context of an encouraging and loving environment where every person feels uniquely cared for.
- 401k + employer match
- Medical insurance coverage (Medical, Dental, Vision) starting day one of employment
- Work life balance – we mean it! 17 days of personal time off (PTO), 12 holidays observed annually, sick time
- And additional benefits
Salary/Wage base range for this role is $159,939 - $191,926 / year + Bonus + Equity. WelbeHealth offers competitive total rewards package that includes, 401k match, healthcare coverage and a broad range of other benefits. Actual pay will be adjusted based on experience and other qualifications.
Compensation
$159,939—$191,926 USD
COVID-19 Vaccination Policy
At WelbeHealth, our mission is to unlock the full potential of our vulnerable seniors. In this spirit, please note that we have a vaccination policy for all our employees and proof of vaccination, or a vaccine declination form will be required prior to employment. WelbeHealth maintains required infection control and PPE standards and has requirements relevant to all team members regarding vaccinations.
Our Commitment to Diversity, Equity and Inclusion
At WelbeHealth, we embrace and cherish the diversity of our team members, and we're committed to building a culture of inclusion and belonging. We're proud to be an equal opportunity employer. People seeking employment at WelbeHealth are considered without regard to race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information or characteristics (or those of a family member), pregnancy or other status protected by applicable law.
Beware of Scams
Please ensure your application is being submitted through a WelbeHealth sponsored site only. Our emails will come from @welbehealth.com email addresses. You will never be asked to purchase your own employment equipment. You can report suspected scam activity to [email protected]
Top Skills
What We Do
WelbeHealth provides full-service care to help seniors age well at home and in their community, often at no cost. Services include medical, coordination, home care, dental, transport, physical therapy, prescriptions, social activities and meals.
Founded by a seasoned group of physician entrepreneurs, our leadership team hails from leading payer and provider organizations such as GoHealth Urgent Care, BAYADA Home Health, AirStrip Technologies, Evolent Health, and On Lok.
With funding from leading venture investors, we're looking for team members who are inspired to help us deliver on our mission of unlocking the full potential of the most vulnerable seniors. Our colleagues are energized by working in diverse groups toward our shared purpose, are eager to drive groundbreaking innovations, and have the courage to care for our participants with empathy and love.
