Subject Matter Expert - Senior Healthcare Actuarial SME

Job Location: 

This role is 100% remote.

Clearance:

Must be currently authorized to work in the United States on a full-time basis and have the ability to obtain a Public Trust Security Clearance. 

Job Description:

Blake Willson Group is seeking a Senior Healthcare Actuarial Subject Matter Expert (SME) to lead the actuarial evaluation of proposals supporting a major federal managed healthcare procurement with an estimated aggregate value approaching $1 trillion. The consultant will independently assess complex medical and dental cost projections, actuarial methodologies, utilization assumptions, trend factors, risk adjustments, rate-development approaches, and supporting data under accelerated procurement timelines. This position will develop defensible actuarial findings and recommendations to support proposal evaluation, clarification, negotiation, and source-selection activities. In this position, you will also:

• Lead actuarial analysis of complex medical and dental healthcare proposals valued at nearly $1 trillion.
• Review solicitation requirements, actuarial instructions, evaluation criteria, data specifications, amendments, and Government assumptions for compliance.
• Evaluate actuarial models, rate development methodologies, utilization, unit costs, trend factors, risk adjustments, population assumptions, and provider-network impacts.
• Assess the quality, completeness, credibility, and consistency of claims, encounter, eligibility, membership, provider, and utilization data.
• Analyze key actuarial assumptions, including IBNR, seasonality, benefit changes, population mix, geographic variation, reimbursement, network discounts, credibility, and normalization.
• Independently test material calculations, models, sensitivity analyses, and scenarios for mathematical and methodological accuracy.
• Benchmark Offeror assumptions and results against historical experience, independent estimates, Government assumptions, market data, and other available benchmarks.
• Identify methodological weaknesses, unsupported assumptions, data limitations, inconsistencies, uncertainty, and potential financial or performance risks.
• Develop clarification questions and negotiation recommendations, including supporting rationale and potential financial impact.
• Prepare Price Analysis Report sections, briefings, exhibits, and negotiation-support materials; update analyses through proposal revisions and negotiations while maintaining traceable workpapers, applying applicable actuarial standards, and protecting sensitive information.

Required Skills:

• Bachelor’s degree in Actuarial Science, Mathematics, Statistics, Economics, Healthcare Analytics, or a related field.
• 6+ years of experience performing managed-care actuarial analysis for a Federal healthcare program or major payer, including proposal, bid, or rate-submission evaluation.
• 6+ years of experience analyzing healthcare utilization, unit cost, trend, IBNR, risk adjustment, provider reimbursement, and network pricing, with demonstrated experience developing, reviewing, or validating complex healthcare cost projections.
• 6+ years of experience developing written actuarial findings that support proposal clarifications and negotiation positions, preferably with ASA/FSA or equivalent health-actuarial experience and Federal acquisition experience, including direct collaboration with Contracting Officers or proposal evaluators.

Desired Skills:

• Experience supporting Federal or state healthcare procurements, proposal evaluations, rate reviews, or contract negotiations, including direct collaboration with Contracting Officers, evaluators, pricing specialists, or acquisition personnel.
• Experience with Medicare, Medicaid, TRICARE, VA Community Care, FEHB, commercial managed care, or comparable large-scale healthcare programs.
• Experience evaluating health-plan, TPA, provider-network, medical, dental, or pharmacy proposals and developing formal actuarial reports, proposal findings, rate certifications, or negotiation-support analyses.
• ASA, FSA, or extensive equivalent health-actuarial experience, with knowledge of applicable Actuarial Standards of Practice related to data quality, modeling, credibility, healthcare cost estimates, and actuarial communications.
• Experience using SQL, SAS, R, Python, Power Query, Power BI, or other actuarial and analytical tools, with the ability to independently evaluate complex actuarial assumptions and communicate findings to senior stakeholders.
• Demonstrated ability to deliver accurate, defensible actuarial products under compressed source-selection and procurement timelines, while clearly communicating findings to technical, financial, and Government decision-makers.

At Blake Willson Group, we believe in transparency and fairness in compensation practices. For this position, we offer a competitive salary range of $130,000 to $180,000 in the United States. Your individual salary within this range will be determined by various factors, including but not limited to your education, experience, skills, and geographic location. We also provide a comprehensive Total Rewards package, which includes major medical benefits such as dental and vision coverage, a 401(k)-contribution plan, holiday and personal time off, professional development training & certification benefits, health & wellness subsidies, paid time off for community service, and more. We value your contributions and are committed to recognizing and rewarding your performance and the value you bring to our business.