Director Risk Adjustment and Quality Analytics - Actuarial
HybridMedicare AdvantageACA ExchangeMedicaidPredictive Modelling & MLBusiness Intelligence & ReportingRisk Management, ERM & ORSA
Role Summary
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Director-level health actuarial role focused on Risk Adjustment and Quality Analytics at a Minnesota Blue Cross plan. Lead analytics for Medicare, ACA, and Medicaid risk score computation, forecasting, RADV audit support, and performance measurement. Manage a team, influence pricing/budget decisions, and build dashboards and provider performance reporting. Hybrid role anchored in Eagan, MN (two days in office per week).
JOB DESCRIPTION SUMMARY
- Lead Risk Adjustment and Quality Analytics for Medicare, ACA, and Medicaid
- Oversee risk score computation, forecasting, and diagnostic coding gap analysis
- Manage and grow a cross-functional analytics team with hiring and performance duties
- Drive dashboards, provider performance metrics, and audit support (RADV/OIG)
- Hybrid role — typically 2 days per week in the Eagan, MN office
DOMAIN EXPERTISE
- Medicare/ACA/Medicaid risk adjustment analytics
- risk score computation and forecasting
- RADV and regulatory audit support
- diagnostic coding gap identification and confidence modeling
- provider performance and engagement analytics
KEY REQUIREMENTS
- 7+ years related experience with 3+ years management experience
- ASA credential or equivalent experience required
- Proficient with statistical software (e.g. SAS) and cloud-based platforms
- Experience with risk score computation and forecasting for Medicare/ACA/Medicaid
- Legal authorization to work in the U.S. required
TECH STACK
- No tech stack specified
