Position Title
Health Pricing Officer / Head of Health Pricing
Function
Product and In-force Management / Health Pricing / Actuarial Pricing
Role Purpose
The Health Pricing Officer is responsible for leading pricing, profitability assessment, and financial governance for health products and health-related propositions. The role ensures that health products are priced sustainably while remaining commercially relevant, customer-focused, partner-ready, and aligned with risk appetite and regulatory expectations.
Given the volatility and complexity of health business, the role must provide strong technical leadership on morbidity assumptions, claims trends, medical inflation, provider behaviour, utilization, underwriting, benefit design, repricing mechanisms, reinsurance, and in-force portfolio sustainability.
Key Responsibilities
1. Health pricing strategy
- Lead pricing strategy for health products, riders, hospital cash, medical reimbursement, critical illness health-related benefits, supplementary health propositions, and distribution-specific health solutions.
- Ensure pricing reflects appropriate view of morbidity, medical inflation, utilization, claim frequency, claim severity, provider behaviour, anti-selection, lapse, expense, commission, and reinsurance.
- Develop pricing recommendations that balance growth, affordability, profitability, customer fairness, sustainability, and shareholder outcome.
- Provide clear views on product structure, benefit limits, waiting periods, exclusions, repricing provisions, claims controls, and risk-sharing mechanisms.
2. New product and product revamp pricing
- Lead health pricing assessments for new launches, repricing, product revamps, campaign offers, bank partner propositions, agency propositions, and tactical health initiatives.
- Prepare and review pricing analyses, financial projections, sensitivities, stress tests, and scenario analysis.
- Support Product Review Reports and approval submissions for health products.
- Ensure financial metrics and risks are clearly explained to senior management, ExComm, regional stakeholders, and approval committees.
- Recommend product design changes where pricing indicates unsustainable economics or customer fairness concerns.
3. Claims experience and medical inflation monitoring
- Monitor health claims experience against pricing assumptions.
- Analyze medical inflation, utilization trends, provider cost patterns, claims leakage, benefit usage, customer segment experience, and distribution channel experience.
- Identify emerging deterioration early and recommend corrective actions.
- Work with Claims, Underwriting, Provider Management, Operations, Risk, and Health Proposition teams to improve claims management and portfolio sustainability.
- Support management actions such as repricing, benefit redesign, claims controls, provider initiatives, underwriting changes, or customer communication.
4. In-force health portfolio management
- Partner with In-force Management to monitor health portfolio profitability and sustainability.
- Identify cohorts, products, partners, or channels with adverse experience.
- Recommend management actions to protect customer value, reduce losses, improve claims ratio, and stabilize long-term economics.
- Support renewal, repricing, and portfolio remediation decisions where relevant.
- Ensure health in-force actions are assessed from customer, regulatory, reputation, and financial perspectives.
5. Reinsurance and risk management
- Assess reinsurance needs for health products and health portfolios.
- Work with reinsurance partners on pricing support, treaty structure, claims risk, morbidity assumptions, and risk transfer.
- Evaluate financial and risk implications of reinsurance arrangements.
- Ensure pricing assumptions appropriately reflect retained risk, ceded risk, and reinsurance cost.
- Support governance and documentation relating to reinsurance-dependent product economics.
6. Governance, controls and approvals
- Act as technical pricing reviewer or approving officer for health product proposals, subject to delegated authority.
- Maintain clear pricing documentation, assumption rationale, model review evidence, sensitivity analysis, and approval trail.
- Ensure health pricing processes meet internal control standards, product launch standards, RCSA expectations, audit readiness, and regulatory requirements.
- Escalate material risks relating to pricing inadequacy, claims deterioration, repricing limitations, customer fairness, or partner economics.
7. Stakeholder partnership
- Work closely with Health Proposition, Product Development, Distribution, Bancassurance, Agency, Finance, Actuarial, Risk, Compliance, Underwriting, Claims, Operations, IT, Regional Health, and external partners.
- Support partner discussions where pricing or benefit design affects commercial positioning, affordability, customer proposition, or risk-sharing.
- Translate complex health pricing issues into clear business recommendations for non-technical stakeholders.
- Provide technical support for regulatory or management queries on health pricing and portfolio sustainability.
8. Team leadership and capability building
- Lead and develop health pricing team members.
- Build capability in health actuarial pricing, claims analytics, medical cost trendanalysis, product economics, reinsurance, and stakeholder communication.
- Strengthen health pricing documentation, model governance, and review discipline.
- Build succession and resilience in the health pricing function.
Key Stakeholders
- Chief Product and In-force Management Officer
- Head of Health Proposition
- Chief Actuary / Appointed Actuary
- CFO and Finance
- Claims, Underwriting, Provider Management and Operations
- Risk, Legal and Compliance
- Bancassurance, Agency and other distribution leaders
- Bank partners and strategic partners
- Regional Health, Pricing and Product teams
- Reinsurers
- Regulators and auditors, where applicable
Required Experience and Capabilities
- Strong actuarial, health pricing, claims analytics, or insurance financial modelling background.
- Understanding of morbidity, medical inflation, utilization, provider cost, antiselection, claims management, underwriting, and health product design.
- Ability to assess complex health risks and convert analysis into practical pricing and portfolio actions.
- Strong commercial judgment, especially in balancing affordability, competitiveness, profitability, and customer fairness.
- Strong stakeholder communication skills, including ability to engage senior management and non-technical audiences.
- Strong governance, documentation, and control mindset.
Preferred Qualifications
- A minimum of Bachelors Degree in Actuarial Science, Mathematics or Statistics
- Minimum 7 years experience in actuarial roles in insurance industry, especially in health pricing roles
- FSA or equivalent
- Experience in life and health insurance, medical reimbursement, hospital cash, critical illness, employee benefits, or health portfolio management.
- Experience working with claims, underwriting, provider networks, reinsurance, product development, or health analytics.
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