Senior Actuary/Financial Analyst
RemoteMedicare AdvantageMedicaidCommercial Employer HealthStop LossExperience StudiesBusiness Intelligence & ReportingPredictive Modelling & ML
Role Summary
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Senior health actuarial role at a healthtech startup (remote, US). You will build and maintain actuarial cost‑savings models, analyze medical and pharmacy claims, and defend savings methodology to actuaries, CFOs, and payer clients across Medicare Advantage, Medicaid MCOs, and commercial lines. Reports into finance leadership and partners closely with clinical, contracting, and data engineering teams.
JOB DESCRIPTION SUMMARY
- Build and maintain actuarial and cost‑savings models for payer engagements
- Analyze member-level medical and pharmacy claims data
- Defend savings methodology to credentialed actuaries and CFOs
- Work across Medicare Advantage, Medicaid MCO, and commercial lines
- Fully remote US role; preference for Central or Eastern time availability
DOMAIN EXPERTISE
- Healthcare actuarial or medical economics experience at a health plan, ACO, consulting firm, or PBM
- Hands-on medical and pharmacy claims analysis experience
- Familiarity with stop-loss/reinsurance accounting and rebate flows
- Knowledge of Part D benefit design and risk-adjustment mechanics
KEY REQUIREMENTS
- 5+ years in healthcare actuarial, medical economics, or related finance roles
- Hands-on experience with medical and Rx claims data
- Familiarity with stop-loss/reinsurance accounting, rebate flows, Part D
- Strong SQL and advanced Excel skills
- Proven ability to present complex methodology to actuaries and CFOs
TECH STACK
- Excel
- PowerPoint
