Medicaid Actuary
HybridMedicaidPricing & RatingRegulatory ReportingBusiness Intelligence & Reporting
Role Summary
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Health actuary role within Iowa HHS Medicaid leading capitation rate development and financial analysis for Medicaid managed care and dental plans. Responsibilities include encounter/claims analysis, forecasting, MLR reporting, and ensuring CMS compliance. Based in Des Moines, IA with a hybrid schedule (two days/week onsite).
JOB DESCRIPTION SUMMARY
- Develop and monitor actuarially sound capitation rates for MCOs and dental plans
- Analyze encounter and claims data to support rate setting and forecasting
- Prepare MLRs, financial reconciliations, and compliance documentation
- Hybrid role — report to the Des Moines Lucas Building two days per week
- Ideal for an Associate-level health actuary with Medicaid experience
DOMAIN EXPERTISE
- Knowledge of Medicaid programs and policies
- Experience conducting actuarial studies and rate setting
- Experience analyzing encounter and claims data
- Proficiency with SAS, R, and SQL
KEY REQUIREMENTS
- Graduation from an accredited college with coursework in math, statistics, or actuarial science
- Minimum of 3 years full-time experience conducting actuarial studies (or approved substitutions)
- Knowledge of Medicaid programs and policies
- Proficiency with Excel and tools such as SAS, R, and SQL
- Ability to pass a background check and work Monday–Friday schedule
TECH STACK
- Excel
- PowerPoint
