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Role Summary

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HIGHLIGHTS

Senior health actuarial leader (Director/AVP) responsible for pricing, reserving, risk adjustment, and forecasting for Medicare and value-based care products in the United States. Lead a team of actuarial analysts, build actuarial and financial models, and support CMS/CMMI regulatory filings and submissions. Requires extensive experience in health insurance actuarial work and strong technical skills in SQL, SAS, R, and Python.

JOB DESCRIPTION SUMMARY

  • Lead pricing, reserving, risk-adjustment, and forecasting for Medicare/value-based products
  • Develop and maintain actuarial and financial models to support pricing and forecasting
  • Work with finance, underwriting, clinical, and analytics teams; present to executives
  • Manage and mentor junior actuarial analysts and data modellers
  • Use SQL, SAS, R, Python, Excel (VBA) and Tableau or Power BI

DOMAIN EXPERTISE

  • CMS and CMMI program experience (Medicare, MSSP, ACO REACH)
  • CMS risk adjustment modelling (HCC, RxHCC, CDPS)
  • Health insurance pricing and value-based payment pricing
  • Actuarial modelling for premium rate setting, reserving, forecasting

KEY REQUIREMENTS

  • 10+ years actuarial, pricing, or financial analysis experience in health insurance/analytics
  • FSA or ASA (or equivalent) preferred
  • Strong experience with CMS, CMMI, Medicare programs (e.g., MA, MSSP, ACO REACH)
  • Hands-on technical skills: SQL, SAS, R, Python, Excel (including VBA)
  • Demonstrated people management and executive communication experience

TECH STACK

  • Excel
  • Tableau
  • Power_BI
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Role Summary

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HIGHLIGHTS

Senior health actuarial leader (Director/AVP) responsible for pricing, reserving, risk adjustment, and forecasting for Medicare and value-based care products in the United States. Lead a team of actuarial analysts, build actuarial and financial models, and support CMS/CMMI regulatory filings and submissions. Requires extensive experience in health insurance actuarial work and strong technical skills in SQL, SAS, R, and Python.

JOB DESCRIPTION SUMMARY

  • Lead pricing, reserving, risk-adjustment, and forecasting for Medicare/value-based products
  • Develop and maintain actuarial and financial models to support pricing and forecasting
  • Work with finance, underwriting, clinical, and analytics teams; present to executives
  • Manage and mentor junior actuarial analysts and data modellers
  • Use SQL, SAS, R, Python, Excel (VBA) and Tableau or Power BI

DOMAIN EXPERTISE

  • CMS and CMMI program experience (Medicare, MSSP, ACO REACH)
  • CMS risk adjustment modelling (HCC, RxHCC, CDPS)
  • Health insurance pricing and value-based payment pricing
  • Actuarial modelling for premium rate setting, reserving, forecasting

KEY REQUIREMENTS

  • 10+ years actuarial, pricing, or financial analysis experience in health insurance/analytics
  • FSA or ASA (or equivalent) preferred
  • Strong experience with CMS, CMMI, Medicare programs (e.g., MA, MSSP, ACO REACH)
  • Hands-on technical skills: SQL, SAS, R, Python, Excel (including VBA)
  • Demonstrated people management and executive communication experience

TECH STACK

  • Excel
  • Tableau
  • Power_BI

Job Overview

Salary
Salary not specified
Years of Experience
10+ Years
Work Type
Permanent
Full Time

Ideal Candidate Profile

Seasoned Director/AVP actuarial professional with 10+ years in health insurance or healthcare analytics, experience with Medicare/CMS programs, near-ASA/FSA or credentialed, strong SQL/SAS/R/Python skills and proven people leadership.

Benefits

Generous VacationPaid Parental LeaveBonus EligibleHealth InsuranceDental InsuranceVision InsuranceShort/Long Term DisabilityLife Insurance
Shortlist Forming
Closing Soon
81d
81 days ago

Strategy: Speed over Perfection

By Day 21, visibility drops significantly. Recruiters are focusing on existing candidates.

"Don't wait for a cover letter. The requisition could close tomorrow. Apply now."

Job Overview

Salary
Salary not specified
Years of Experience
10+ Years
Work Type
Permanent
Full Time

Ideal Candidate Profile

Seasoned Director/AVP actuarial professional with 10+ years in health insurance or healthcare analytics, experience with Medicare/CMS programs, near-ASA/FSA or credentialed, strong SQL/SAS/R/Python skills and proven people leadership.

Benefits

Generous VacationPaid Parental LeaveBonus EligibleHealth InsuranceDental InsuranceVision InsuranceShort/Long Term DisabilityLife Insurance
Shortlist Forming
Closing Soon
81d
81 days ago

Strategy: Speed over Perfection

By Day 21, visibility drops significantly. Recruiters are focusing on existing candidates.

"Don't wait for a cover letter. The requisition could close tomorrow. Apply now."

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