Actuarial Analyst - Healthcare Payer
PEOPLE FORCE CONSULTING INC
Role Summary
Role type
Healthcare data transformation builder
Closer to a data-transformation build role than a modelling-heavy actuarial position because the emphasis is on reconstructing definitions, lineage, and processes rather than developing actuarial models.
Titled below the requirements. The title says Actuarial Analyst, while the requirements call for a senior profile with 10+ years of healthcare payer experience and broad cross-functional expertise.
Senior Health actuarial data consulting role, remote in the United States. You will connect healthcare payer actuarial, underwriting, HEDIS/Quality, claims, enrollment, provider, and financial processes to data architecture and business rules, using SQL to profile, validate, and document complex data flows. The role requires 10+ years of healthcare payer experience and bridges business SMEs with technical and data teams.
Requirements
Must have
- 10+ years of healthcare payer experience
Strongly preferred
- Strong healthcare payer domain experience
- Expertise in Actuarial, Underwriting, and HEDIS/Quality functions
- Strong understanding of healthcare cost and utilization concepts including PMPM, IBNR, MLR
- Experience with major healthcare payer data domains (claims, enrollment, provider, premium, quality)
- Strong ability to understand system architecture, data lineage, and end-to-end data flows
- Strong SQL and data analysis skills
- Experience with data profiling, reconciliation, validation, mapping, and business-rule discovery
- Ability to reverse-engineer business logic from data, applications, existing queries, and SMEs
- Experience documenting business definitions, data rules, data mappings, assumptions, and process/data flows
- Strong analytical and problem-solving skills
- Excellent communication skills and ability to bridge between healthcare business and technical teams
Nice to have
- Experience working within a health plan or on large-scale healthcare payer transformation initiatives
- Experience with modern cloud data platforms such as Snowflake
- Exposure to AI-enabled analytics or natural-language-to-data solutions (e.g., Snowflake Cortex)
Skills & Domain
ToolsSnowflake
DomainHealthcare payer domain and operationsActuarial, Underwriting, and HEDIS/Quality functionsHealthcare cost and utilization concepts (PMPM, IBNR, MLR)
