The Director, Actuarial – Government Programs will lead actuarial pricing, financial performance insights, and strategic analytics across SHP’s Medicare and Medicaid lines of business. This role is critical to ensuring market-competitive, compliant, and financially sustainable products while translating actuarial insights into actionable business decisions.
This leader will operate in a highly matrixed environment, partnering closely with Finance, Product, Network, Risk Adjustment, and Clinical teams to drive enterprise value and support SHP’s growth strategy.
Core Responsibilities
1. Government Programs Pricing & Financial Management
- Lead end-to-end pricing for Medicare Advantage, Medicaid, and related government programs
- Develop and maintain actuarial assumptions, methodologies, and pricing models
- Ensure rate adequacy, competitiveness, and alignment with enterprise financial targets
- Oversee bid development, rate filings, and regulatory submissions
2. Forecasting & Performance Insights
- Translate pricing assumptions into forward-looking financial projections and scenarios
- Monitor emerging experience vs. pricing assumptions and identify key drivers of variance
- Provide actionable insights to improve margin, membership growth, and cost management
3. Regulatory & Compliance Leadership
- Ensure compliance with CMS, state Medicaid agencies, and insurance department requirements
- Support actuarial certifications, rate filings, and audit readiness
- Interface with regulators and external actuarial partners as needed
4. Strategic Partnership & Cross-Functional Leadership
- Partner with Product, Network/Provider Contracting, and Clinical teams on:
- Benefit design and product strategy
- Value-based care and provider reimbursement models
- Cost of care and utilization management strategies
- Align actuarial assumptions with operational and market realities across the enterprise
5. Team Leadership & Talent Development
- Lead and develop a high-performing team of actuaries and analysts
- Establish clear priorities, governance, and quality standards for actuarial work products
- Foster a culture of innovation, continuous improvement, and accountability
6. Enterprise Contribution & Thought Leadership
- Contribute to enterprise planning, budgeting, and long-term strategy
- Present insights and recommendations to senior leadership in a clear, actionable manner
- Identify opportunities for automation, analytics advancement, and process optimization
Qualifications
- Bachelor's Degree Required.
- 5 years Management experience.
- 7 years Actuarial experience.