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 an experienced Senior Healthcare Actuarial Subject Matter Expert (SME) to lead the actuarial evaluation of complex managed healthcare proposals supporting a major federal procurement valued at nearly $1 trillion. The role will evaluate actuarial methodologies, healthcare cost projections, utilization assumptions, trend factors, risk adjustments, rate development, and supporting data to identify deficiencies, risks, and areas requiring clarification or negotiation. The SME will develop actuarial findings for the Price Analysis Report, independently validate Offeror assumptions and models, and communicate the financial impact of actuarial findings to pricing specialists, acquisition personnel, and senior Government decision-makers. 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 Finance, Economics, Mathematics, Actuarial Science, Statistics, Healthcare Administration, or a related field.
• 8+ years of experience in healthcare actuarial analysis, managed-care analytics, healthcare economics, rate development, or related work.
• 6+ years of experience developing, reviewing, or validating managed healthcare cost and utilization projections, including experience with utilization forecasting, medical trend, unit cost, provider reimbursement, risk adjustment, rate development, claims completion/IBNR, or experience studies.
• 6+ years of experience independently evaluating actuarial assumptions and complex models, with advanced Excel, strong technical-writing skills, and the ability to communicate actuarial findings and financial implications to non-actuarial stakeholders under compressed deadlines.

Desired Skills:

• Experience supporting federal or state healthcare procurements, proposal evaluations, rate reviews, or contract negotiations.
• Experience with Medicare, Medicaid, TRICARE, VA Community Care, Federal Employees Health Benefits, commercial managed care, or comparable large healthcare programs.
• Experience evaluating health-plan, third-party administrator, provider-network, medical, dental, or pharmacy proposals.
• Knowledge of applicable Actuarial Standards of Practice, particularly those addressing data quality, modeling, credibility, healthcare cost estimates, and communications.
• Experience using SQL, SAS, R, Python, Power Query, Power BI, or other actuarial and analytical tools.
• Experience preparing formal actuarial reports, proposal-evaluation findings, rate certifications, actuarial opinions, or negotiation-support analyses.

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.