Lead Actuarial Analyst, MA Risk Adjustment
HybridMedicare AdvantageBusiness Intelligence & ReportingPredictive Modelling & MLRegulatory Reporting
Role Summary
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Senior health actuarial analytics role focused on Medicare Advantage risk adjustment based in Seattle (hybrid). You’ll analyze CMS data (MMR/MOR/MAO-004), reconcile submissions to CMS acceptance, model scenarios and forecast RAF impact, and present financial insights to senior leadership.
JOB DESCRIPTION SUMMARY
- Lead Medicare Advantage risk adjustment analytics and RAF reconciliation
- Analyze MMR, MOR, MAO-004 and medical claims to identify revenue opportunities
- Model scenarios and forecast payment accuracy and RAF impact
- Hybrid role based in Seattle with study program and exam support
- Requires 4+ years RA analytics experience and 3+ actuarial exams passed
DOMAIN EXPERTISE
- Risk adjustment analytics
- MMR, MOR, MAO-004 and medical claims analysis
- Medicare Advantage risk adjustment
- RAF leakage reconciliation
KEY REQUIREMENTS
- 4+ years of experience in risk adjustment analytics
- 3+ actuarial exams passed
- Experience analyzing MMR, MOR, MAO-004 and medical claims
- High proficiency in Microsoft Excel and SQL
- Eligible to work in the US without sponsorship
TECH STACK
- Excel
- Power_BI
- Redshift
- Other_BI_Tool