• Director Provider Solutions-New Jersey

    Elevance Health (Woodbridge, NJ)
    …New Jersey market. This role will oversee all lines of business and lead enterprise-wide initiatives to include local cost of care and trend management, innovative ... single point of accountability for all product lines and is the state lead for the Integrated Cost Management (ICM) committee. + Facilitates the implementation of… more
    Elevance Health (07/24/25)
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  • VP Medicaid Markets CEO

    Highmark Health (Pittsburgh, PA)
    …+ Work with Actuary , Finance, Executive Leadership and key business partners, lead the state contract RFP or rate renewal activities to ensure the acquisition, ... for submission to the state, and serving as business lead in negotiations with the state. + Develop and...other external organizations such as BCBSA and NCQA. + Lead and manage the team and organization to execute… more
    Highmark Health (07/08/25)
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  • AVP, Actuarial - Annuity New Business Data…

    Lincoln Financial (Greensboro, NC)
    …opportunity. **Requisition #:** 74820 **The Role at a Glance** The AVP & Actuary , Annuity New Business Data Analytics & Assumptions will manage an actuarial team ... new business work: data analytics and assumptions. For data analytics, you will lead your team to assemble, visualize, and make predictions on relevant data from… more
    Lincoln Financial (07/11/25)
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  • Director, Corporate Insurance & Risk Management

    7-Eleven (Irving, TX)
    …and operations. The Director will manage relationships with external partners and lead internal teams handling claims, legal matters, and financial reporting. Key ... the organization's comprehensive insurance and risk management strategy. + Build, lead , and manage relationships with brokers, carriers, Third Party Administrators… more
    7-Eleven (06/27/25)
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  • VP Risk Adjustment Accuracy Management

    Highmark Health (Pittsburgh, PA)
    …individual providers, provider groups and the network as a whole 3. Analytics + Lead a team that develops and oversees analysis of risk adjustment programs including ... impact at the plan and provider group level. + Lead a team that develops and supports analytics related...issues and proficiency in the healthcare industry + Credentialed Actuary (FSA/ASA) or Advanced Degree (MBA) Language (Other than… more
    Highmark Health (04/30/25)
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  • Regional Vice President (RVP) Provider Solutions…

    Elevance Health (Norfolk, VA)
    …minimum of 10 years of experience in healthcare operations, finance, underwriting, actuary , network development, and/or sales; or any combination of education and ... creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are… more
    Elevance Health (07/25/25)
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  • Decision Science Analyst Senior - Claims Analytics

    USAA (Colorado Springs, CO)
    …will be joining the Claims Analytics team, which is a part of P&C Actuary & Analytics.** **They will work directly with Claim's business partners on benefit ... + Leverages advanced business, analytical and technical knowledge to participate or lead discussions with cross functional teams to understand and collaborate highly… more
    USAA (07/23/25)
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  • Corporate Director Network Strategy

    AmeriHealth Caritas (Newtown Square, PA)
    …with business development, product leadership, medical management, pricing and actuary , provider performance programs, and local provider network resources to ... lead and deploy programmatic solutions, as well as to respond to proposals + Manages operational reporting team, as well as the provider experience team, including… more
    AmeriHealth Caritas (07/23/25)
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  • Clinical Pharmacist, Senior

    Premera Blue Cross (Mountlake Terrace, WA)
    …business support to key internal and external stakeholders. + Manage and lead clinical pharmacy programs that may include: + Pharmacy Utilization Management/Prior ... + Support pharmacy benefit design development in collaboration with Product Services, Actuary , and the Pharmacy Benefit Manager partner. + Support medical management… more
    Premera Blue Cross (07/11/25)
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  • Director, Medical Cost Economics

    UPMC (Pittsburgh, PA)
    **Purpose:** The Department of Health Economics is seeking a credentialed health actuary with a strong background analyzing claims data. This position would drive ... problem-solving and strategic decision-making involving medical cost improvement strategies. + Lead the development of detailed actuarial and financial models which… more
    UPMC (06/21/25)
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