Director, Actuarial

City/State

Work Shift

Overview:

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 ​[202510-SHP...entity_EDJ | Word]​

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

Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.

In support of our mission “to improve health every day,” this is a tobacco-free environment.

For positions that are available as remote work, Sentara Health employs associates in the following states:

Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.