Senior Actuary, Health Plan Analytics
New
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JobgetherHealthcare Analytics
United StatesFull-TimeSenior
Salary150,000 - 185,000 USD per year
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Job Details
- Experience
- 7+ years
- Required Skills
- PythonSQLMicrosoft Power BITableauR
Requirements
- 7+ years of actuarial or actuarial-adjacent analytics experience in health plan pricing, risk adjustment, or medical economics.
- Experience modeling performance across at least three healthcare markets: Medicare Advantage, MAPD, ACA, Medicaid, or value-based contracts.
- Strong understanding of CMS-HCC and ACA risk models, RAF calculations, ICD-10 coding, and risk adjustment revenue.
- Experience building member-level data models for analytics platforms or dashboards like Tableau or Power BI.
- Proficiency in SQL and statistical or scripting languages such as SAS, R, or Python.
- Familiarity with healthcare data sources including MMR, MOR, MAO-004, and EDGE encounter submissions.
- Bachelor’s degree in actuarial science, mathematics, statistics, economics, or another quantitative discipline.
- ASA, FSA designation, or active progress toward actuarial certification.
- Ability to communicate complex actuarial findings to executive audiences.
Responsibilities
- Build and maintain member-level actuarial models focused on risk adjustment performance, HCC capture, medical economics, and population health metrics.
- Develop analytics supporting pricing strategies, Medicare Advantage bids, ACA rate filings, and value-based contract decisions.
- Reconcile risk adjustment calculations and integrate analytical logic into customer-facing dashboards.
- Partner with data engineering and product teams to design methodologies and create user-friendly visualizations.
- Create forecasting and accrual models for financial planning, settlement estimates, and transfer payments.
- Analyze utilization trends and medical loss ratio drivers to identify financial optimization opportunities.
- Support audit readiness by modeling risk exposure and prioritizing chart review and coding activities.
- Communicate actuarial methodologies and findings to executive stakeholders.
- Collaborate with clinical, coding, and provider engagement teams to drive quality improvement.
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