Pricing Actuary-Medicare Advantage

Location: Remote USA

Salary: $175,000–$250,000 per year

Company

hirify.global is a healthcare company founded in 2017 that combines an integrated care platform, advanced data and AI, and clinical and service experiences to improve the health and well-being of older Americans.

What you will do

• Direct the end-to-end development, modeling, and submission of annual Medicare Advantage Part C and Part D bids in compliance with CMS guidelines and statutory deadlines.
• Partner with product, clinical, local market, finance, healthcare economics, network management, and other stakeholders on benefit design, pricing assumptions, and financial targets.
• Build, refine, and maintain scalable bid pricing models with strong technical accuracy, governance, automation, and repeatable execution.
• Perform sensitivity and scenario analyses covering CMS payment policy changes, risk model updates, benchmark shifts, and competitive market dynamics.
• Translate CMS Call Letters, Bid Instructions, and Rate Announcements into modeling changes and executive guidance.
• Validate claims, enrollment, and risk adjustment data and present bid strategy, financial returns, and risk profiles to executives, board members, and regulatory reviewers.

Requirements

• 8+ years of progressive healthcare actuarial experience, including at least 5+ years of direct Medicare Advantage bid pricing, plan design, and CMS bid submission experience.
• Proven ability to complete complex, time-sensitive projects on schedule while managing high-stakes regulatory deadlines.
• Advanced proficiency in actuarial modeling, claims data extraction, and financial modeling tools such as SQL, Python, R, SAS, or advanced Excel modeling.
• Thorough knowledge of Medicare Advantage pricing mechanics, including Part D direct subsidy and benefit design, CMS-HCC and RxHCC risk adjustment models, Star Ratings financial impacts, and benchmark calculations.
• Exceptional interpersonal and collaborative leadership skills, including the ability to translate complex actuarial concepts into clear strategic choices for non-actuarial partners.

Nice to have

• ASA or FSA credentials from the Society of Actuaries and MAAA membership; equivalent practical mastery and bid leadership experience are accepted.
• Experience with reserving, underwriting, risk adjustment operations, or medical economics.
• Comfort working in a fast-paced, high-growth environment with continuously refined processes.

Culture & Benefits

• Collaborative, respectful, diverse, and supportive work environment.
• Employer-sponsored health, dental, and vision plans with low or no premium.
• Generous paid time off, parental leave, and a $100 monthly mobile or internet stipend.
• Stock options for all employees and bonus eligibility for roles below Director level.
• 401(k) program and additional total rewards for full-time employees.