Investigate and resolve travel medical claims end-to-end, adjudicate benefits, process invoices, maintain updates, document claims, assess medical management, identify fraud, and communicate with customers.
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Responsibilities
Investigate, evaluate, and resolve travel medical claims end-to-end
Adjudicate benefits per policy terms and statutory requirements
Process invoices through cost-containment networks
Maintain clear, timely updates to customers, providers, and partners on claim status
Document thoroughly in the claims system and ensure complete, high-quality files
Requirements
Nice to have: startup or high-growth environment experience
Lead actuarial and analytics advisor for US-based health plan and provider clients, shaping risk strategies and driving business growth in managed care and value-based care.
Locations (3)
Chicago, Illinois, United States
San Francisco, California, United States
Los Angeles, California, United States
Compensation
The salary range for this position (intended for U.S. applicants) is $235,000-$255,000 annually.
Responsibilities
Lead actuarial and analytics advisory for US-based clients
Shape client risk strategies for value-based care and ACO programs
Translate complex actuarial analyses into actionable recommendations
Lead executive-level client meetings and presentations
Direct design and review of models for value-based contracts
The pay range for the role is $83,600 to $119,900. The specific offer will depend on an applicant’s skills and other factors. This role may also be eligible to participate in a discretionary annual incentive program.
Responsibilities
Manage an inventory of claims involving moderate severity exposures and coverage issues.
Conduct, coordinate, and direct investigation into loss facts, damages and risk transfer opportunities.
Evaluate coverage, liability, and damages to determine the exposure to the insured and the policy.
Analyze coverage and communicate coverage positions, as warranted, within assigned authority.
Demonstrate and implement effective defense, resolution and claim strategies.
This position is responsible for participating in implementation, maintenance and basic analysis of models, studies and systems which use actuarial principles for the purposes of pricing, underwriting, statistics, reserving, forecasting and other actuarial functions; running, building and analyzing results of basic models; developing oral and written presentation skills; and learning basic business and actuarial concepts.
Compensation
Base Pay Range
$92,700.00 - $167,500.00
Exact compensation may vary based on skills, experience, and location.
Responsibilities
Participate in implementation, maintenance and basic analysis of actuarial models and systems
Run, build and analyze results of basic models
Develop oral and written presentation skills
Learn basic business and actuarial concepts
Requirements
Bachelor degree in Actuarial Science, Mathematics, Statistics or Economics
Nice to have: Commercial health insurance products
Perform actuarial analyses for assigned areas of the business, develop and maintain models, and collaborate across functions to support decision making.
Perform actuarial analyses for assigned areas of the business, apply sound methods and judgment, and explain results and drivers to stakeholders.
Develop, enhance, and maintain actuarial models, tools, and methodologies that support business decisions, with an emphasis on automation and efficiency.
Identify manual, repetitive, or error-prone processes, and build and maintain automated workflows and reports in SQL, Python, VBA, or R that improve speed, accuracy, controls, and repeatability.
Translate reporting, regulatory, and analytical needs into clear data requests for Data Engineering and Program Managers, and act as an ongoing liaison on data sources, definitions, and quality.
Lead and manage a team of claims professionals overseeing complex, high‑severity excess casualty claims, providing technical direction, quality assurance, and stakeholder collaboration.
Compensation
The estimated salary range for this position is $180,000.00 - $225,000.00 per year.
Responsibilities
Review and assign new loss notices and oversee the timely, effective handling of Excess claims
Provide technical direction on complex, high‑severity, coverage‑sensitive, and litigated claims
Review open claim files to ensure appropriate investigation, coverage analysis, reserving, evaluation, documentation, reporting, and resolution strategies
Monitor claim reserves and expenses to ensure they appropriately reflect anticipated exposures and established claim handling procedures
Provide guidance on Excess/Umbrella coverage, including complex coverage issues and communication of coverage positions
Requirements
Bachelor's degree from a four‑year college or university
Juris Doctor (J.D.)
Nice to have: Juris Doctor (J.D.)
Nice to have: CPCU or other advanced claims training/designation
Work with stakeholders across the organization to align how data is defined and reported so results are consistent across actuarial and other reporting.
10+ years of experience in Business Analysis, Systems Analysis, Insurance Consulting or Financial Services Consulting.
Strong experience in the P&C Insurance (Property & Casualty) domain.
Experience working with MGA, MGU or Insurance Carrier environments is highly preferred.
Hands-on experience in data mapping, source-to-target mapping and data transformation requirements.
Strong understanding of insurance processes, including premiums, claims, reserving and financial reporting.
Experience in BI, reporting, data or analytics transformation projects.
Experience in requirements gathering, functional documentation, stakeholder management and UAT.
Knowledge of SQL and data analysis is preferred.
Experience working in Agile or phased delivery environments.
Excellent communication, presentation, facilitation and stakeholder management skills.
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