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Role Summary

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HIGHLIGHTS

Senior health actuarial analyst focusing on Medicare Advantage risk adjustment in Raleigh, NC. You will analyze CMS and claims data, model scenarios, reconcile RAF leakage, and develop business cases to inform financial and operational decisions. The role requires 4+ years in risk adjustment analytics and 3+ actuarial exams passed, with hybrid-remote flexibility.

JOB DESCRIPTION SUMMARY

  • Lead Medicare Advantage risk adjustment analytics and RAF reconciliation
  • Analyze CMS files (MMR, MOR, MAO-004) and medical claims data
  • Build forecasts, scenario models, and ROI-focused business cases
  • High Excel and SQL proficiency; experience with Power BI and Redshift
  • Hybrid-remote role based in Raleigh, NC with a 10% target bonus

DOMAIN EXPERTISE

  • Risk adjustment analytics
  • Analysis of MMR, MOR, and MAO-004 files
  • Medical claims data analysis
  • RAF leakage reconciliation and reconciliation to CMS acceptance

KEY REQUIREMENTS

  • 4+ years of experience in risk adjustment analytics
  • 4+ years analyzing MMR, MOR, MAO-004 and medical claims data
  • 3+ actuarial exams passed
  • High proficiency in Microsoft Excel and SQL
  • Eligible to work in the US without visa sponsorship

TECH STACK

  • Excel
  • Power_BI
  • Redshift
  • PowerPoint
  • Other_BI_Tool
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Role Summary

Loading...

HIGHLIGHTS

Senior health actuarial analyst focusing on Medicare Advantage risk adjustment in Raleigh, NC. You will analyze CMS and claims data, model scenarios, reconcile RAF leakage, and develop business cases to inform financial and operational decisions. The role requires 4+ years in risk adjustment analytics and 3+ actuarial exams passed, with hybrid-remote flexibility.

JOB DESCRIPTION SUMMARY

  • Lead Medicare Advantage risk adjustment analytics and RAF reconciliation
  • Analyze CMS files (MMR, MOR, MAO-004) and medical claims data
  • Build forecasts, scenario models, and ROI-focused business cases
  • High Excel and SQL proficiency; experience with Power BI and Redshift
  • Hybrid-remote role based in Raleigh, NC with a 10% target bonus

DOMAIN EXPERTISE

  • Risk adjustment analytics
  • Analysis of MMR, MOR, and MAO-004 files
  • Medical claims data analysis
  • RAF leakage reconciliation and reconciliation to CMS acceptance

KEY REQUIREMENTS

  • 4+ years of experience in risk adjustment analytics
  • 4+ years analyzing MMR, MOR, MAO-004 and medical claims data
  • 3+ actuarial exams passed
  • High proficiency in Microsoft Excel and SQL
  • Eligible to work in the US without visa sponsorship

TECH STACK

  • Excel
  • Power_BI
  • Redshift
  • PowerPoint
  • Other_BI_Tool

Job Overview

Salary
$99k - $124k
Years of Experience
4+ Years
Work Type
Permanent
Full Time

Ideal Candidate Profile

Ideal for a senior health actuarial analyst with 4+ years in Medicare Advantage risk adjustment, 3+ actuarial exams passed, strong SQL and Excel skills, and the ability to translate CMS data into financial insights.

Benefits

Hybrid WorkHealth InsuranceDental InsuranceVision Insurance401(k) PlanAnnual BonusGenerous VacationPaid Sick LeaveWellness ProgramTraining Budget
Fresh Role
Premium Window
1d
1 days ago

Strategy: Maximize Application Quality

Applications submitted within 72 hours are 2x more likely to land an interview.

"Recruiters are actively watching. Take time to tailor your keywords."

Job Overview

Salary
$99k - $124k
Years of Experience
4+ Years
Work Type
Permanent
Full Time

Ideal Candidate Profile

Ideal for a senior health actuarial analyst with 4+ years in Medicare Advantage risk adjustment, 3+ actuarial exams passed, strong SQL and Excel skills, and the ability to translate CMS data into financial insights.

Benefits

Hybrid WorkHealth InsuranceDental InsuranceVision Insurance401(k) PlanAnnual BonusGenerous VacationPaid Sick LeaveWellness ProgramTraining Budget
Fresh Role
Premium Window
1d
1 days ago

Strategy: Maximize Application Quality

Applications submitted within 72 hours are 2x more likely to land an interview.

"Recruiters are actively watching. Take time to tailor your keywords."

Health/Other/IC Level
Strive Health

Lead Actuarial Analyst, MA Risk Adjustment

Strive Health•Raleigh, North Carolina, United States•1d ago
HybridMedicare AdvantagePredictive Modelling & MLBusiness Intelligence & ReportingExperience Studies

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