Actuarial Manager (Medicare)
Medicare AdvantageMedicaidACA ExchangePricing & RatingPredictive Modelling & MLBusiness Intelligence & Reporting
Role Summary
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Manager-level health actuarial role focused on Medicare (MSSP ACO and Medicare Advantage) engagements in the US. You will lead actuarial financial analyses, build PMPM and medical cost projection models, advise on CMS/MSSP rules, and present results to health plan and provider leadership. Senior candidate with strong Medicare and rate-development experience.
JOB DESCRIPTION SUMMARY
- Lead actuarial analyses for MSSP ACOs and Medicare Advantage clients
- Build and maintain PMPM medical cost and utilization trend models
- Use SAS/SQL/R/Python and CCW VRDC Medicare claims for analysis
- Senior IC/Manager role mentoring analysts and leading client engagements
- Support business development, proposals, and actuarial product development
DOMAIN EXPERTISE
- Medicare and MSSP ACO financial analysis
- Rate development and rate review for Medicare programs
- Benchmark development and savings calculation methodology
- PMPM medical cost projection and utilization trend analysis
- Experience accessing CMS CCW VRDC Medicare claims data
KEY REQUIREMENTS
- 6+ years of healthcare actuarial experience
- Significant Medicare-focused experience, including MSSP knowledge
- Experience with Medicare rate development or rate review processes
- Proficiency with SAS, SQL, R, or Python for modelling and analysis
- Experience in consulting, health plan, or managed care actuarial roles
TECH STACK
- No tech stack specified
