Director – Actuary
Director – Actuary
Who We Are:
TurningPoint Healthcare Solutions is a leader in advanced clinical and technology-enabled complex condition management. TurningPoint provides an innovative suite of specialty care management services and technologies that enable health plans and employers to improve the safety, quality, and affordability of healthcare. Through its platform and specialized team of clinical experts, TurningPoint works collaboratively with providers to deliver optimal care. TurningPoint offers condition-specific, quality-driven, value-based care management services that optimize care from diagnosis and discovery through recovery. TurningPoint’s comprehensive and integrated suite of services enhances the support individuals need, at the time they need it most. Since launching in 2015, TurningPoint has provided support to more than 50 million people nationwide across numerous clinical specialties including musculoskeletal, pain management, cardiology, wound care, ear/nose/throat, and sleep. TurningPoint’s model moves beyond denial-based care to holistic condition management that improves outcomes and reduces cost. TurningPoint is an independent organization, not owned or affiliated with a health plan or provider system.
Position Summary and Responsibilities:
This opportunity requires a highly analytical financial leader with consistent results in adding value through actuarial and analytical analysis. The Director - Actuary will be responsible and accountable for initiating and leading the development of actuarial studies, underwriting and pricing models, and predictive analyses for the business.
Develop a comprehensive pricing and underwriting strategy, including establishment of pricing governance processes and controls, as well as sales support including direct interaction with clients in the form of written and verbal presentations of proposals, assistance with contract negotiations, etc.
Apply actuarial techniques and statistical analysis across several functions, including claim trend analysis, experience studies, medical economics, profitability analysis, risk adjustment, predictive modeling, and/or claim reserving.
Support ongoing financial reconciliation processes for value-based care contracts, including eligibility, revenue, and claims reconciliation as well as ad hoc financial operations reporting, provider network analysis, and fee schedule pricing
Independently initiate and lead the development of complex actuarial studies, analyses, and presentation materials needed to appropriately inform decision makers. Make appropriate recommendations to senior management across teams both within the finance department and across other departments to optimize value-based contract performance
Design, build, and manage risk adjustment models, leveraging public methodologies (e.g., Medicaid, Medicare, Marketplace) as well as proprietary approaches. Ensure model accuracy through calibration, validation, and continuous performance monitoring, and translate outputs into actionable insights for pricing and value-based care strategy.
Actively participate in senior leadership meetings, preparing and presenting relevant documents, reports and plans in a timely manner
Assist senior leadership in financial models and analysis to support strategic partnerships and initiatives
Process improvements within areas of oversight. Develops and implements plans/projects to improve operational efficiency and effectiveness.
Hiring and development of staff and succession planning. Communicates goals, objectives, accountabilities, priorities, and authority parameters to assigned staff. Develops leaders through mentoring and coaching of direct reports.
Building and managing a strong actuarial team is a must, including inspiring, leading, mentoring, measuring and appraising the actuarial team to ensure stellar capabilities at all levels as well as driving a culture of financial accuracy and accountability
Education, Experience and Licensure:
Bachelor’s Degree in Mathematics, Statistics, Actuarial Science, Finance, Economics or related field.
ASA in the Society of Actuaries required, FSA strongly preferred
Membership in the American Academy of Actuaries
Preferred Education, Experience and Licensure:
Minimum of seven (8+) plus years of healthcare actuarial or similar experience.
Proven track record of excelling in high performance, analytic and data-driven cultures and in high growth corporate, venture capital or private equity funded environment.
Possesses and applies a comprehensive and in-depth knowledge of actuarial principles, concepts, practices and processes as well as healthcare claims data
Experience leading diverse teams and managing cross functional projects to drive corporate initiatives
Prior experience in partner/provider analytics, payer-provider contracting, or value-based care
Possesses significant expertise to complete complex assignments and ability to visualize, articulate, and solve complex problems while leading others to complete complex assignments
Ability to present highly technical concepts to technical and non-technical audiences
Proficiency in SQL, SAS, or an understanding of Python strongly preferred
Location: Remote. Corporate office is located in Lake Mary, Florida and would require only very limited travel.
TurningPoint Healthcare Solutions is an Equal Opportunity Employer.
Apply Now
Who We Are:
TurningPoint Healthcare Solutions is a leader in advanced clinical and technology-enabled complex condition management. TurningPoint provides an innovative suite of specialty care management services and technologies that enable health plans and employers to improve the safety, quality, and affordability of healthcare. Through its platform and specialized team of clinical experts, TurningPoint works collaboratively with providers to deliver optimal care. TurningPoint offers condition-specific, quality-driven, value-based care management services that optimize care from diagnosis and discovery through recovery. TurningPoint’s comprehensive and integrated suite of services enhances the support individuals need, at the time they need it most. Since launching in 2015, TurningPoint has provided support to more than 50 million people nationwide across numerous clinical specialties including musculoskeletal, pain management, cardiology, wound care, ear/nose/throat, and sleep. TurningPoint’s model moves beyond denial-based care to holistic condition management that improves outcomes and reduces cost. TurningPoint is an independent organization, not owned or affiliated with a health plan or provider system.
Position Summary and Responsibilities:
This opportunity requires a highly analytical financial leader with consistent results in adding value through actuarial and analytical analysis. The Director - Actuary will be responsible and accountable for initiating and leading the development of actuarial studies, underwriting and pricing models, and predictive analyses for the business.
Develop a comprehensive pricing and underwriting strategy, including establishment of pricing governance processes and controls, as well as sales support including direct interaction with clients in the form of written and verbal presentations of proposals, assistance with contract negotiations, etc.
Apply actuarial techniques and statistical analysis across several functions, including claim trend analysis, experience studies, medical economics, profitability analysis, risk adjustment, predictive modeling, and/or claim reserving.
Support ongoing financial reconciliation processes for value-based care contracts, including eligibility, revenue, and claims reconciliation as well as ad hoc financial operations reporting, provider network analysis, and fee schedule pricing
Independently initiate and lead the development of complex actuarial studies, analyses, and presentation materials needed to appropriately inform decision makers. Make appropriate recommendations to senior management across teams both within the finance department and across other departments to optimize value-based contract performance
Design, build, and manage risk adjustment models, leveraging public methodologies (e.g., Medicaid, Medicare, Marketplace) as well as proprietary approaches. Ensure model accuracy through calibration, validation, and continuous performance monitoring, and translate outputs into actionable insights for pricing and value-based care strategy.
Actively participate in senior leadership meetings, preparing and presenting relevant documents, reports and plans in a timely manner
Assist senior leadership in financial models and analysis to support strategic partnerships and initiatives
Process improvements within areas of oversight. Develops and implements plans/projects to improve operational efficiency and effectiveness.
Hiring and development of staff and succession planning. Communicates goals, objectives, accountabilities, priorities, and authority parameters to assigned staff. Develops leaders through mentoring and coaching of direct reports.
Building and managing a strong actuarial team is a must, including inspiring, leading, mentoring, measuring and appraising the actuarial team to ensure stellar capabilities at all levels as well as driving a culture of financial accuracy and accountability
Education, Experience and Licensure:
Bachelor’s Degree in Mathematics, Statistics, Actuarial Science, Finance, Economics or related field.
ASA in the Society of Actuaries required, FSA strongly preferred
Membership in the American Academy of Actuaries
Preferred Education, Experience and Licensure:
Minimum of seven (8+) plus years of healthcare actuarial or similar experience.
Proven track record of excelling in high performance, analytic and data-driven cultures and in high growth corporate, venture capital or private equity funded environment.
Possesses and applies a comprehensive and in-depth knowledge of actuarial principles, concepts, practices and processes as well as healthcare claims data
Experience leading diverse teams and managing cross functional projects to drive corporate initiatives
Prior experience in partner/provider analytics, payer-provider contracting, or value-based care
Possesses significant expertise to complete complex assignments and ability to visualize, articulate, and solve complex problems while leading others to complete complex assignments
Ability to present highly technical concepts to technical and non-technical audiences
Proficiency in SQL, SAS, or an understanding of Python strongly preferred
Location: Remote. Corporate office is located in Lake Mary, Florida and would require only very limited travel.
TurningPoint Healthcare Solutions is an Equal Opportunity Employer.
Apply Now