Clinical Risk Manager Jobs in Detroit, MI (NOW HIRING)

Reporting to the Health Alliance Plan Chief Financial Officer, the Vice President, Chief Actuary and Underwriting Leader is responsible for actuarial strategy, pricing, underwriting, rate filings, reserving, forecasting, trend analysis, Medicare Advantage bids, model oversight, and related financial analytics. This role serves as a key advisor to Health Alliance Plan and Henry Ford Health leaders, providing actuarial insight to support enterprise forecasting, risk adjustment, value-based care, financial performance, and board/executive decision-making. The leader collaborates with Health Alliance Plan executives and enterprise stakeholders to develop and execute strategies that support pricing integrity, regulatory compliance, competitive products, sustainable membership growth, revenue performance, and operating margin goals.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

• Works closely with the CFO to ensure the Long-Range Financial Plan reflects the current environment as part of a complex Integrated Delivery Financial System (IDFS).
• Leads actuarial strategy, premium rate development, and regulatory rate filings for Health Alliance Plan and affiliated companies across commercial fully insured and self-funded, and Medicare Advantage products; partners with HAP CareSource on Medicaid and Michigan Coordinated Health (MICH) products.
• Develops and maintains reserving and forecasting models, trend analyses, benchmarks, and calculations to support medical cost projections, performance reporting, and financial planning.
• Provides actuarial and financial insight for annual medical expense budgets, variance reporting, provider contracting, network analysis, and value-based care strategies.
• Oversees commercial pricing and underwriting activities to support competitive rates, appropriate risk selection, revenue growth, membership growth, profitability, and regulatory compliance.
• Oversees actuarial activities for Medicare Advantage, including bid development, service area expansion analysis, risk adjustment strategy, CMS-related financial requirements, and related audits or inquiries.
• Partners cross-functionally with Finance, Product Development, Sales, Operations, Clinical, Risk Adjustment, Compliance, Legal, Provider Contracting, and senior leadership to align actuarial recommendations with benefit design, product strategy, business development, and enterprise execution.
• Establishes and maintains actuarial governance processes, including assumption documentation, model validation, pricing controls, reserve review, and appropriate review or sign-off protocols for material actuarial work.
• Ensures actuarial practices comply with applicable CMS, state regulatory, statutory reporting, internal control, and Actuarial Standards of Practice requirements.
• Advises on employer group and broker discussions as needed, providing actuarial guidance on premium rates, market conditions, and financial strategy.
• Builds, leads, and develops a high-performing actuarial and underwriting team, ensuring strong collaboration, technical excellence, and continuous improvement.
• Partners with value-based care providers to develop appropriate stop loss rates.
• Performs other related duties as assigned.

EDUCATION/EXPERIENCE REQUIRED:

• Bachelor’s degree in actuarial science, mathematics, finance, statistics, economics, or another quantitative discipline required; master’s degree preferred.
• Minimum of seven years of progressive health actuarial experience, including pricing, product development, valuation, forecasting, financial reporting, and risk analysis.
• Experience supporting health plan products such as commercial, individual, Medicare Advantage, Medicaid, supplemental, or self-funded lines of business preferred.
• Demonstrated ability to develop actuarial models, analyze medical cost trends, and translate complex financial information into actionable business recommendations.
• Prior leadership experience, including building teams, developing employees, and managing direct or indirect reports.
• Proven ability to collaborate across Finance, Sales, Product, Operations, and senior leadership to support business strategy and financial performance.
• Strong knowledge of healthcare economics, risk adjustment, reserving, forecasting, pricing, Medicare Advantage bid strategy, value-based care economics, and actuarial model governance.
• Executive-level communication skills, including the ability to translate complex actuarial analysis into clear recommendations for senior leadership, board audiences, and cross-functional stakeholders.

CERTIFICATIONS/LICENSURES REQUIRED:

FSA and MAAA designations preferred if serving as Appointed Actuary. ASA candidates with significant health plan actuarial leadership experience may be considered.

HAP is a Michigan-based, nonprofit health plan that provides health coverage to individuals, companies and organizations. A subsidiary of Henry Ford Health System, we partner with doctors, employers and community groups to enhance the overall health and well-being of the lives we touch. With more than 1,100 dedicated and passionate employees, our goal is to make health care easy for our members.

Under the leadership of President and CEO Robert G. Riney, Henry Ford Health is a

$6 billion integrated health system comprised of six hospitals, a health plan, and 250+ sites

including medical centers, walk-in and urgent care clinics, pharmacy, eye care facilities and

other healthcare retail. Established in 1915 by auto industry pioneer Henry Ford, the health system

now has 32,000 employees and remains home to the 1,900-member Henry Ford Medical Group, one

of the nation’s oldest physician groups. An additional 2,200 physicians are also affiliated with the

health system through the Henry Ford Physician Network. Henry Ford is also one of the region’s

major academic medical centers, receiving between $90-$100 million in annual research funding and

remaining Michigan’s fourth largest NIH-funded institution. Also an active participant in medical

education and training, the health system has trained nearly 40% of physicians currently practicing

in the state and also provides education and training for other health professionals including nurses,

pharmacists, radiology and respiratory technicians. visitHenryFord.com .

Whether it's offering a new medical option, helping you make healthier lifestyle choices or

making the employee enrollment selection experience easier, it's all about choice. Henry

Ford Health System has a new approach for its employee benefits program - My Choice

Rewards. My Choice Rewards is a program as diverse as the people it serves. There are

dozens of options for all of our employees including compensation, benefits, work/life balance

and learning - options that enhance your career and add value to your personal life. As an

employee you are provided access to Retirement Programs, an Employee Assistance Program

(Henry Ford Enhanced), Tuition Reimbursement, Paid Time Off, Employee Health and Wellness

and access to day care services at Bright Horizons Midtown Detroit, and a whole host of other

benefits and services. Employee's classified as contingent status are not eligible for benefits

Equal Employment Opportunity / Affidicated Employer Henry Ford Health System is committed to the hiring, advancement and fair treatment of all individuals without regard to race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height, weight, marital status, family status, gender identity, sexual orientation, and genetic information, or any other protected status in accordance with applicable federal and state laws.