Lead Actuarial Analyst, MA Risk Adjustment
HybridMedicare AdvantagePredictive Modelling & MLBusiness Intelligence & ReportingRegulatory Reporting
Role Summary
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Senior health actuarial role focused on Medicare Advantage risk adjustment in Chicago. You’ll analyze CMS and claims data, reconcile RAF leakage, build financial models and business cases, and present findings to senior leadership. Requires 4+ years in risk adjustment and 3+ actuarial exams passed. Hybrid role with remote flexibility and in-person needs in Chicago.
JOB DESCRIPTION SUMMARY
- Lead Medicare Advantage risk adjustment analytics and RAF reconciliation
- Analyze CMS datasets (MMR, MOR, MAO-004) and medical claims
- Build scenarios, forecasts, and business cases to inform investments
- Prepare presentations and recommendations for senior leadership
- Hybrid role: work from home with in-person office/clinic/home visit needs
DOMAIN EXPERTISE
- Risk adjustment analytics
- Analyzing MMR, MOR, MAO-004 files and medical claims
- CMS data reconciliation and RAF leakage analysis
- Building financial forecasts and business cases
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 with Microsoft Excel and SQL
- Eligible to work in the US (no visa sponsorship available)
TECH STACK
- Excel
- Power_BI
- Redshift
- PowerPoint
- Other_BI_Tool