[Remote] Director of Actuarial Analytics and Insights
Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a company that delivers a reputed company platform for health plans and provider organizations navigating value-based care. They are seeking a Senior Actuary to reputed company health plan and risk adjustment analytics, building member-level actuarial models and translating them into customer-facing dashboards to inform pricing and reputed company.
Responsibilities
- 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
Skills
- 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
- 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
Benefits
- Medical, Dental and reputed company benefits
- 401k match
- Generous PTO plan
reputed company