Actuarial Analyst, Consultant
HybridMedicare AdvantageACA ExchangePredictive Modelling & MLReserving & ValuationExperience Studies
Role Summary
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Senior health actuarial analyst focused on risk adjustment retrospective analytics for Medicare Advantage and ACA chart review programs in Oakland, CA. You will develop chart targeting lists, quantify financial impact, build predictive models, and support reserves and financial forecasting. Reports to the Manager of Risk Adjustment Retrospective Analytics in a hybrid work model.
JOB DESCRIPTION SUMMARY
- Lead retrospective risk adjustment analytics for Medicare Advantage and ACA chart review
- Develop chart targeting, quantify program financial impact, and validate vendor data
- Build predictive models and forecasting using R, Python, SQL or SAS
- Senior role requiring 6+ years actuarial experience, reporting to the Analytics Manager
- Hybrid role — office presence required at least two times per month (Oakland, CA)
DOMAIN EXPERTISE
- Medicare Advantage chart review analytics
- ACA chart review analytics
- Healthcare enrollment and claims processing experience
- Revenue and expense accounting experience
KEY REQUIREMENTS
- 6+ years of professional actuarial experience
- Bachelor’s degree required (math, statistics, CS minor or equivalent)
- Healthcare enrollment and claims processing and finance experience required
- Proficiency with MS Office (Excel, Word, PowerPoint)
- Strong ability to create and validate analytic processes and communicate to executives
TECH STACK
- Excel
- PowerPoint
