Diane Seaman may have one of the toughest jobs in corporate America.

Ms. Seaman is the chief actuary for  WellPoint Inc., the insurer which projects to enroll more than 600,000 in the new health care exchanges — likely the most for any insurer. It’s her job to develop rates for dozens of different offerings around the country. But for people who thrive on information, these can be harrowing times.

The health law has reshaped the way insurers do business. Before the law, consumers often had to tell insurers if they had health conditions that might require pricey care, such as diabetes. Insurers could typically boost those consumers’ premiums or refuse to cover them. Now, insurers must accept all comers and they get no health information on enrollees.

That means that actuaries have little to go on when predicting medical costs — and setting premiums. What’s more, frequent regulatory tweaks from policy makers have forced actuaries to rejigger their projections and strategies on the fly. This is raising the stakes for actuaries, a word traced back to the Latin root for bookkeeper.

The rate-setting process under the law has been “very, very stressful,” says Ms. Seaman. Late last year, after hearing on the radio about one rule change that effectively threw a wrench into years of work, the typically even-keeled 53-year-old found herself hitting the steering wheel during the commute to her Louisville, Ky., office. “I can’t believe this!” she said. (Ms. Seaman says she was surprised by the announcement, not opposed to the policy.)

WellPoint Chief Executive Joseph R. Swedish says actuaries’ work is “the critical ingredient in terms of how our business operates…. without actuarial analysis, we really are shooting in the dark.”

Last year, actuaries and insurance executives had to make big bets on how things would play out for 2014, and some missed the mark. Based on actuarial projections from an outside firm, Houston-based Community Health Choice Inc. posted marketplace rates about 30% above its cheapest competitor. Regulators wouldn’t allow the nonprofit to cut its prices, and it got far fewer sign-ups than it had projected.

“We all knew we were making our best educated guess, and we guessed wrong,” says CEO Ken Janda. Community Health Choice is working with its actuaries and hoping to bring down next year’s rates, he said.

Trying to interpret the regulations last year, “I longed for the specificity of an equation,” says Janice Knight, chief actuary of Health Care Service Corp., parent of Blue Cross and Blue Shield plans in Texas, Illinois and other states.

Elaine Corrough, an actuary at consultancy Axene Health Partners in Murrieta, Calif. who sometimes speaks on behalf of the Society of Actuaries, says that to unwind, she turns to crocheting, which is “like doing spreadsheets, but with yarn.”

She recalls finding a colleague at his desk one morning last spring wearing the same outfit as the day before. Ms. Corrough pulled her own office all-nighters last year. And one day last week, she was in the office until 10 p.m., and then arrived back at 4 a.m.

Many actuaries say this year’s rate process won’t be much easier than last time. They will still lack a clear picture of the likely health costs of their 2014 customers before they make their calls for 2015. Some enrollees signed up as late as this month. Even for those whose coverage started earlier, there is a months long lag time before companies process the claims that reveal what sort of health care their enrollees are getting.

Read more: Is this the hardest job in America?

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