Director, Actuarial Services
Medical Home Network
Director, Actuarial Services
Chicago,
United States•6mo ago
HybridMedicare AdvantageMedicaidCommercial Employer Health
Role Summary
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Director-level health actuarial role in Chicago focused on value-based care for Medicare Advantage, Medicaid, and commercial contracts. Lead actuarial modeling, RAF forecasting, and contract risk evaluation to inform contracting, performance monitoring, and enterprise risk strategy. Collaborate with finance, growth, clinical, coding, and data science teams. Hybrid role with preference for candidates within 50 miles of Chicago.
JOB DESCRIPTION SUMMARY
- Lead actuarial modeling and financial forecasting for Medicare Advantage, MSSP/REACH, and Medicaid
- Design and evaluate value-based payment models including shared savings and capitation
- Own enterprise risk adjustment strategy and prospective RAF forecasting
- Partner with contracting, clinical, coding, finance, and data science teams
- Hybrid: 2 days onsite in Chicago, 3 days remote (fully remote considered outside 50-mile radius)
DOMAIN EXPERTISE
- value-based care contracts and shared savings/capitation models
- MSSP/ACO REACH and Medicare Advantage operations
- risk adjustment and RAF forecasting
- MA STARS and MA bid process familiarity
- projections of premiums, costs, MLR, and MA forecasting
KEY REQUIREMENTS
- 8+ years in healthcare and 5+ years doing healthcare actuarial analyses
- ASA or FSA designation required
- Deep experience with Medicare Advantage, MSSP/ACO REACH, and Medicaid value-based programs
- Strong data skills with SAS and SQL; familiar with R and Python
- Bachelor’s degree required; master’s preferred
TECH STACK
- Excel
- PowerPoint
