Lead Actuarial Analyst, MA Risk Adjustment
HybridMedicare AdvantageBusiness Intelligence & ReportingRegulatory Reporting
Role Summary
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Senior health actuarial analyst focused on Medicare Advantage risk adjustment based in Washington, DC (hybrid). You will analyze CMS and claims data, reconcile RAF leakage, build forecasts and business cases, and present financial insights to senior leadership. Requires 4+ years in risk adjustment analytics and 3+ actuarial exams passed.
JOB DESCRIPTION SUMMARY
- Lead Medicare Advantage risk adjustment analytics and RAF reconciliation
- Translate CMS performance data into revenue impact and forecasts
- Build business cases and present recommendations to senior leadership
- Hybrid role—work from home with in-person office, clinic, or patient visits
- Requires 4+ years RA analytics experience and 3+ actuarial exams passed
DOMAIN EXPERTISE
- Risk adjustment analytics
- MMR, MOR, MAO-004 and medical claims analysis
- RAF leakage and CMS submissions reconciliation
KEY REQUIREMENTS
- 4+ years of experience in risk adjustment analytics
- 3+ actuarial exams passed (actuarial student level)
- 4+ years analyzing MMR, MOR, MAO-004 and medical claims data
- High proficiency in Microsoft Excel and SQL
- Eligible to work in the US without sponsorship
TECH STACK
- Excel
- Power_BI
- Redshift
- PowerPoint
- Other_BI_Tool