Role Summary

HIGHLIGHTS

Senior health actuarial role focused on Medicare Advantage risk adjustment analytics in Pittsburgh, PA. You will analyze CMS and claims files, reconcile RAF leakage, forecast revenue impact, and build business cases to inform operational and financial decisions. Requires 4+ years in RA analytics and 3+ actuarial exams passed. Hybrid-remote role with study support and an actuarial exam program.

JOB DESCRIPTION SUMMARY

Lead Risk Adjustment analytics for Medicare Advantage (MA) performance and RAF reconciliation
Analyze CMS files (MMR, MOR, MAO-004) and medical claims to find revenue opportunities
Build forecasts, scenario models, and business cases to inform investment decisions
Hybrid role: work from home with in-person needs at office, clinic, or patient homes
Actuarial Study Program with exam fee support and rewards for passing exams

DOMAIN EXPERTISE

Risk adjustment analytics
MMR, MOR, MAO-004 and medical claims data analysis
RAF leakage reconciliation and CMS submissions reconciliation
Forecasting and revenue impact analysis

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 (no visa sponsorship available)

TECH STACK

Excel
Power_BI
Redshift
Other_BI_Tool

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Role Summary

HIGHLIGHTS

JOB DESCRIPTION SUMMARY

Lead Risk Adjustment analytics for Medicare Advantage (MA) performance and RAF reconciliation
Analyze CMS files (MMR, MOR, MAO-004) and medical claims to find revenue opportunities
Build forecasts, scenario models, and business cases to inform investment decisions
Hybrid role: work from home with in-person needs at office, clinic, or patient homes
Actuarial Study Program with exam fee support and rewards for passing exams

DOMAIN EXPERTISE

Risk adjustment analytics
MMR, MOR, MAO-004 and medical claims data analysis
RAF leakage reconciliation and CMS submissions reconciliation
Forecasting and revenue impact analysis

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 (no visa sponsorship available)

TECH STACK

Excel
Power_BI
Redshift
Other_BI_Tool

Role Summary

HIGHLIGHTS

JOB DESCRIPTION SUMMARY

Lead Risk Adjustment analytics for Medicare Advantage (MA) performance and RAF reconciliation
Analyze CMS files (MMR, MOR, MAO-004) and medical claims to find revenue opportunities
Build forecasts, scenario models, and business cases to inform investment decisions
Hybrid role: work from home with in-person needs at office, clinic, or patient homes
Actuarial Study Program with exam fee support and rewards for passing exams