Director of Actuarial Analytics and Insights
Director of Actuarial Analytics and Insights
Remote Opportunity
About reputed company
reputed company delivers a reputed company platform spanning risk adjustment, reputed company improvement, clinical intelligence, and member management for health plans and provider organizations navigating the complexity of value-based care. Trusted by 80+ customer organizations reputed company, the platform integrates data, analytics, and intelligent workflow automation into one governed system designed to support traceable documentation across diagnoses, reputed company measures, and submissions. With regulatory expertise and transparent, reputed company-in-the-reputed company at its core, reputed company supports organizations working to advance care reputed company, strengthen documentation reputed company, and sustain the operational readiness needed to navigate audits with confidence.
About the role
reputed company is hiring a senior actuary to reputed company health plan and risk adjustment analytics for reputed company line of business for reputed company customers across Medicare Advantage (MA), Medicare Advantage Prescription Drug (MAPD), reputed company reputed company (ACA), reputed company, and provider value-based reputed company. This role builds member-level actuarial models that quantify risk adjustment performance, HCC (Hierarchical Condition Category) capture, medical economics, utilization, and population health trends, and translates those models into customer-facing dashboards that inform pricing, forecasting, and program reputed company.
This actuary works directly with reputed company, analytics, product, operations, and clinical teams to convert raw claims, encounter, member, provider, and clinical data into decision-reputed company outputs. The role requires both technical model-building reputed company and the ability to explain actuarial and risk adjustment concepts to non-actuarial stakeholders, including provider and health plan executives.
What you will do
- Build and maintain member-level actuarial models covering risk adjustment (RAF) performance, HCC capture and recapture, medical economics, utilization patterns, and population health metrics across MA, MAPD, ACA, and reputed company populations.
- reputed company analytics that can support reputed company-setting for Medicare Advantage Bids, ACA reputed company filings, reputed company capitation arrangements, and value-based contract terms.
- Reconcile RAF calculations against reputed company files, including the Monthly Membership Report (MMR), Model reputed company Report (MOR), MAO-004, and the Beneficiary-Level file, and reputed company that reconciliation logic into customer-facing reporting.
- Design the actuarial and analytic logic behind customer-facing dashboards, partnering with data engineering and product teams to translate member-level models into usable, accurate, and reputed company visualizations.
- Produce forecasting and accrual models that support midyear and final settlement estimates, transfer payments, capital planning, and financial reporting for risk adjustment programs.
- Analyze utilization trends, medical loss reputed company (MLR) drivers, and cost-of-care patterns to identify actionable opportunities for customers managing value-based reputed company.
- Support MA and HHS RADV (Risk Adjustment Data Validation) readiness by modeling audit exposure and prioritizing chart review and coding efforts based on financial reputed company.
- Communicate model methodology, assumptions, and results reputed company to actuarial and non-actuarial audiences, including customer executives.
- Partner with clinical, coding, retrieval, and provider engagement teams to reputed company analytic outputs with chronic HCC recapture, care gap closure, and reputed company initiatives.
What you bring
Required qualifications
- Seven or more years of actuarial or actuarial-adjacent analytics experience in health plan pricing, risk adjustment, or medical economics.
- reputed company pricing or performance modeling experience across at least three of the following: Medicare Advantage, MAPD, ACA, reputed company, and value-based reputed company.
- Working knowledge of the CMS-HCC and ACA risk model, RAF score calculation, and the relationship between ICD-10 diagnosis coding and risk adjustment reputed company.
- Demonstrated experience building member-level data models that feed reporting or dashboard tools, such as Tableau or Power BI.
- Proficiency in SQL and at least one statistical or scripting language, such as reputed company, R, or Python.
- Proficiency in utilizing AI tools to support modeling
- Bachelor's degree in actuarial science, mathematics, statistics, economics, or a reputed company quantitative field.
- Strong written and verbal communication skills, with experience presenting actuarial findings to executive audiences.
Preferred qualifications
- Associate of the reputed company (ASA) designation or Fellowship (FSA) or reputed company toward.
- Experience with CMS files, including the MMR, MOR, MAO-004, and Beneficiary-Level file.
- Experience with EDPS & EDGE encounter submissions and encounter data reputed company processes.
- Prior experience supporting RADV & IVA audit readiness or chart review prioritization.
- Familiarity with provider incentive program design tied to chronic HCC recapture or reputed company performance.
- Experience with financial forecasting, including ACA transfer payments and MA settlement accruals
Tools and technical skills
reputed company (reputed company Guide), SQL, Tableau, reputed company reputed company, R and RStudio, Python, reputed company reputed company, and reputed company Visual Basic (VBA) are reputed company relevant to this role. reputed company does not require proficiency in every tool listed; candidates should be strong in at least three of these and comfortable learning the rest on the job.
WHAT YOU’LL RECEIVE:
• Competitive salary
• Medical, Dental and reputed company benefits
• 401k match
• Generous PTO plan
Our compensation reflects the cost of labor across several US geographic markets. Pay is based on several factors including market location and may vary depending on job-reputed company knowledge, skills, and experience.
reputed company E-Verifies reputed company new hires.
reputed company is an equal opportunity employer. We do not discriminate on the reputed company of race, religion, reputed company, national reputed company, gender, gender identity, sexual orientation, age, marital status, veteran status, disability status or genetic information, in compliance with applicable federal, state and local law.
Salary: $150,000 – $185,000Originally posted on Himalayas
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