Director of Actuarial Analytics and Insights
R
ReveleerHealth Insurance Tech
United StatesFull-TimeDirector
Salary150,000 - 185,000 USD per year
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Job Details
- Experience
- Seven or more years
- Required Skills
- PythonSQLMicrosoft Power BITableauR
Requirements
- Seven or more years of actuarial or actuarial-adjacent analytics experience in health plan pricing, risk adjustment, or medical economics.
- Experience modeling across at least three of: Medicare Advantage, MAPD, ACA, Medicaid, or value-based contracts.
- Working knowledge of CMS-HCC and ACA risk models, RAF score calculation, and ICD-10 diagnosis coding.
- Experience building member-level data models feeding reporting tools such as Tableau or Power BI.
- Proficiency in SQL and at least one statistical or scripting language (SAS, R, or Python).
- Proficiency in utilizing AI tools to support modeling.
- Bachelor's degree in actuarial science, mathematics, statistics, economics, or related quantitative field.
- Strong written and verbal communication skills for presenting to executive audiences.
Responsibilities
- Build and maintain member-level actuarial models covering risk adjustment performance, medical economics, utilization, and population health metrics.
- Support rate-setting for Medicare Advantage Bids, ACA rate filings, and Medicaid capitation arrangements.
- Reconcile RAF calculations against CMS source files including MMR, MOR, and MAO-004.
- Design actuarial logic for customer-facing dashboards in partnership with data engineering and product teams.
- Produce forecasting and accrual models for risk adjustment programs and financial reporting.
- Analyze utilization trends and MLR drivers to identify value-based contract opportunities.
- Model audit exposure and prioritize chart review efforts for RADV readiness.
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