Lead Actuarial Analyst, MA Risk Adjustment
HybridMedicare AdvantagePredictive Modelling & MLBusiness Intelligence & ReportingExperience Studies
Role Summary
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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