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 Marketplace Lead Actuary will lead pricing strategy and rate filing development for ACA marketplace products while ensuring compliance with state and federal regulations. This role combines technical actuarial expertise with leadership and strategic business planning to drive sustainable growth in the individual market. In addition to rate filing, this role will support research and modeling for product expansion feasibility projects, research medical cost improvement opportunities, lead quarterly forecast, and support other ongoing and ad-hoc actuarial or analytics research.

JOB SPECIFICATIONS 

  • Lead annual rate filing development process for ACA marketplace products.
  • Develop and maintain pricing models for individual market products.
  • Analyze market dynamics, competitor positioning, and historical experience.
  • Monitor and project risk adjustment transfer payments.
  • Partner with Product and Network teams to optimize plan designs and provider arrangements.
  • Ensure compliance with state and federal filing requirements.
  • Present pricing recommendations to senior leadership.
  • Coordinate with state regulators during rate review process.
  • Monitor emerging experience and develop quarterly forecasts.
  • Support organizational planning through market analysis and financial projections.


QUALIFICATIONS:

  • Education/Specialized Training/Licensure: Bachelors Degree in Mathematics, Actuarial Science, or related field required. Associate of the Society of Actuaries (ASA) required.
  • Fellow of the Society of Actuaries (FSA) preferred.
  • Work Experience (Years and Area): 2+ years of Medicare Advantage pricing and bid development experience required.
  • 5+ years of Actuarial experience required.
  • 4+ years of Medicare Advantage pricing and bid development experience preferred.
  • 7+ years of Actuarial experience prferred.
  • Management Experience (Years and Area): 2+ years of management experience preferred.
  • Software Proficiencies: Excel, SQL Excel, MS SQL Server

 

Other:

  • Knowledge of risk adjustment methodologies
  • Experience with actuarial modeling tools and marketplace 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 marketplace 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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