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Associate Director Actuarial Services, Nashville TN or Remote


Medical Director


Nashville, Tennessee, United States

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Come make an impact on the communities we serve as we help advance health equity on a global scale. Here, you will find talented peers, comprehensive benefits, a culture guided by diversity and inclusion, career growth opportunities and your life's best work.(sm)

Why naviHealth?

At naviHealth, our mission is to work with extraordinarily talented people who are committed to making a positive and powerful impact on society by transforming health care.
naviHealth is the result of almost two decades of dedicated visionary leaders and innovative organizations challenging the status quo for care transition solutions. We do health care differently and we are changing health care one patient at a time.

Why is this role critical?

The Manager, Actuarial Services will play a key role in leading all risk-based contracts through naviHealth’s Medicare Advantage line of business. This position presents a unique opportunity for an actuary to impact the healthcare industry through driving a Value Based Care model and guiding operational decisions based on analysis and risk evaluation.

You’ll enjoy the flexibility to work remotely* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

  • Lead and develop an Actuarial team to include oversight of financial performance measurements across multiple health plans
  • Provide strategic guidance and analysis on whether internal and external projects, solutions, or investments are likely to lower healthcare costs and to what degree
  • Collaborate with Business Development, Operational, and Clinical teams on initiatives to ensure appropriate and relevant healthcare cost and health economic factors are captured using mathematical modelling techniques and statistical concepts to determine probability and assess risks to price Medicare services
  • Demonstrate effective leadership to drive consensus on complex and cross functional projects with Finance, Clinical Outcomes, and Analytics
  • Develop, oversee, and provide reports of Medicare cost impact models which include economic and statistical analyses
  • Continuously enhance metrics and benchmarks (both internal and external) in analyses to proactively identify and evaluate both leading and trailing indicators of Medicare costs that may affect economic and Medicare cost impact models
  • Forecasting monthly revenue from health plan clients
  • Client reconciliation overview

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

  • Bachelor’s degree
  • ASA or FSA designation
  • 6+ years of actuarial experience in the healthcare industry
  • People leader experience

Preferred Qualifications:

  • Deep experience with health insurance products, particularly Medicare Advantage, including compliance and filing, rating, and product development
  • Reserving experience
  • Advanced knowledge of medical claims data
  • Reasonable experience with SQL
  • Well-organized with the ability to manage complex projects and enterprise functions across multiple lines of business and internal stakeholders
  • Well-developed oral and written communication skills

About naviHealth

Being a pioneer in post-acute management and care transitions with 19 years of experience, naviHealth is uniquely positioned to manage patients, improve clinical and financial outcomes, and share risk with payors and providers. We provide clinical service support alongside proprietary technology and advisory solutions that empower health systems, health plans and post-acute providers to navigate care episodes across the continuum, with the goal of reducing waste and improving patient outcomes.

Our values

  • We care about the people we serve
  • We care about each other
  • We care about our communities
  • We embrace innovation
  • We like simple

Careers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.

California, Colorado, Connecticut, Nevada, New York City, or Washington Residents Only: The salary range for California, Colorado, Connecticut, Nevada, New York City, or Washington residents is $101,200 to $184,000. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.