Role Summary

HIGHLIGHTS

Senior Actuary role in a US remote health plan analytics team. You will lead actuarial modeling focused on risk adjustment, pricing, forecasting, and population health for Medicare Advantage, ACA, Medicaid, and value-based care programs. Build member-level models, collaborate across clinical, product, and data teams, and communicate complex findings to executive stakeholders. Ideal for an ASA/FSA with 7+ years in health plan pricing or risk adjustment.

JOB DESCRIPTION SUMMARY

Lead actuarial analytics for Medicare Advantage, ACA, Medicaid, and VBC programs
Build member-level risk adjustment, pricing, and forecasting models
Collaborate with data engineering, product, and clinical teams on insights
Present complex actuarial findings to executive stakeholders
Remote role with competitive salary and study support availability

DOMAIN EXPERTISE

Health plan pricing or risk adjustment
Medicare Advantage, ACA, Medicaid, value-based contract modeling
CMS-HCC risk model, RAF calculations, ICD-10 coding
Member-level data modeling for reporting/dashboards

KEY REQUIREMENTS

7+ years actuarial/analytics experience in health plan pricing, risk adjustment, or medical economics
Experience with multiple market segments (MA, MAPD, ACA, Medicaid, VBC)
Deep knowledge of CMS-HCC risk models, RAF, ICD-10, and risk adjustment revenue
Proficiency in SQL and at least one language (SAS, R, Python)
ASA or FSA designation (or active progress toward it) preferred

TECH STACK

Power_BI
Tableau
Excel

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Role Summary

HIGHLIGHTS

JOB DESCRIPTION SUMMARY

Lead actuarial analytics for Medicare Advantage, ACA, Medicaid, and VBC programs
Build member-level risk adjustment, pricing, and forecasting models
Collaborate with data engineering, product, and clinical teams on insights
Present complex actuarial findings to executive stakeholders
Remote role with competitive salary and study support availability

DOMAIN EXPERTISE

Health plan pricing or risk adjustment
Medicare Advantage, ACA, Medicaid, value-based contract modeling
CMS-HCC risk model, RAF calculations, ICD-10 coding
Member-level data modeling for reporting/dashboards

KEY REQUIREMENTS

7+ years actuarial/analytics experience in health plan pricing, risk adjustment, or medical economics
Experience with multiple market segments (MA, MAPD, ACA, Medicaid, VBC)
Deep knowledge of CMS-HCC risk models, RAF, ICD-10, and risk adjustment revenue
Proficiency in SQL and at least one language (SAS, R, Python)
ASA or FSA designation (or active progress toward it) preferred

TECH STACK

Power_BI
Tableau
Excel

Role Summary

HIGHLIGHTS

JOB DESCRIPTION SUMMARY

Lead actuarial analytics for Medicare Advantage, ACA, Medicaid, and VBC programs
Build member-level risk adjustment, pricing, and forecasting models
Collaborate with data engineering, product, and clinical teams on insights
Present complex actuarial findings to executive stakeholders
Remote role with competitive salary and study support availability

DOMAIN EXPERTISE

Health plan pricing or risk adjustment
Medicare Advantage, ACA, Medicaid, value-based contract modeling
CMS-HCC risk model, RAF calculations, ICD-10 coding
Member-level data modeling for reporting/dashboards

KEY REQUIREMENTS

7+ years actuarial/analytics experience in health plan pricing, risk adjustment, or medical economics
Experience with multiple market segments (MA, MAPD, ACA, Medicaid, VBC)
Deep knowledge of CMS-HCC risk models, RAF, ICD-10, and risk adjustment revenue
Proficiency in SQL and at least one language (SAS, R, Python)
ASA or FSA designation (or active progress toward it) preferred