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Role Summary

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HIGHLIGHTS

Senior health actuarial analytics role focused on Medicare Advantage (MA) risk adjustment in Pittsburgh, PA (hybrid). Lead analyses of CMS and claims data to quantify RAF leakage, forecast revenue impacts, and build business cases for operational investments. Requires strong Excel and SQL skills and 3+ actuarial exams passed.

JOB DESCRIPTION SUMMARY

  • Lead Medicare Advantage risk adjustment analytics and RAF leakage reconciliation
  • Translate CMS and claims data into financial insights and forecasts
  • Build business cases and present recommendations to senior leadership
  • 3+ actuarial exams passed; 4+ years in risk adjustment analytics required
  • Hybrid-remote role based in Pittsburgh, PA; tech: Excel, SQL, Power BI, Redshift

DOMAIN EXPERTISE

  • Risk adjustment analytics
  • Analyzing MMR, MOR, MAO-004 and medical claims data
  • Medicare Advantage (MA) RAF leakage reconciliation
  • Developing forecasts and financial impact analyses

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 sponsorship

TECH STACK

  • Excel
  • Power_BI
  • Redshift
  • Other_BI_Tool
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Role Summary

Loading...

HIGHLIGHTS

Senior health actuarial analytics role focused on Medicare Advantage (MA) risk adjustment in Pittsburgh, PA (hybrid). Lead analyses of CMS and claims data to quantify RAF leakage, forecast revenue impacts, and build business cases for operational investments. Requires strong Excel and SQL skills and 3+ actuarial exams passed.

JOB DESCRIPTION SUMMARY

  • Lead Medicare Advantage risk adjustment analytics and RAF leakage reconciliation
  • Translate CMS and claims data into financial insights and forecasts
  • Build business cases and present recommendations to senior leadership
  • 3+ actuarial exams passed; 4+ years in risk adjustment analytics required
  • Hybrid-remote role based in Pittsburgh, PA; tech: Excel, SQL, Power BI, Redshift

DOMAIN EXPERTISE

  • Risk adjustment analytics
  • Analyzing MMR, MOR, MAO-004 and medical claims data
  • Medicare Advantage (MA) RAF leakage reconciliation
  • Developing forecasts and financial impact analyses

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 sponsorship

TECH STACK

  • Excel
  • Power_BI
  • Redshift
  • Other_BI_Tool

Job Overview

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

Ideal Candidate Profile

An associate-level health actuary with 4+ years in MA risk adjustment, 3+ exams passed, strong Excel/SQL skills, and experience translating CMS data into actionable financial insights.

Benefits

Hybrid WorkHealth InsuranceDental InsuranceVision InsuranceLife InsuranceShort/Long Term Disability401(k) PlanAnnual BonusExam Fees PaidExam Bonuses
Fresh Role
Premium Window
0d
Posted Today

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

An associate-level health actuary with 4+ years in MA risk adjustment, 3+ exams passed, strong Excel/SQL skills, and experience translating CMS data into actionable financial insights.

Benefits

Hybrid WorkHealth InsuranceDental InsuranceVision InsuranceLife InsuranceShort/Long Term Disability401(k) PlanAnnual BonusExam Fees PaidExam Bonuses
Fresh Role
Premium Window
0d
Posted Today

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•Pittsburgh, Pennsylvania, United States•5h ago
HybridMedicare AdvantageBusiness Intelligence & ReportingPredictive Modelling & MLRegulatory Reporting

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