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Role Summary

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HIGHLIGHTS

Senior Health actuary (Sr. Director) leading risk adjustment analytics, predictive modeling, and encounter submission platforms for Commercial, Medicare Advantage, Medicaid and ACA lines. Responsible for end-to-end data, model development, regulatory submissions, and signing actuarial filings. Senior leadership role reporting to the VP of Medical Economics and Risk Adjustment. Remote role with required residence in certain Northeastern US states.

JOB DESCRIPTION SUMMARY

  • Lead enterprise risk adjustment data, analytics, modeling, and encounter submissions
  • Develop predictive models to optimize risk scores and measure coding/clinical accuracy
  • Oversee actuarial forecasts, valuations, and sign regulatory actuarial filings
  • Manage and mentor analytics and actuarial staff; 7+ years supervisory experience required
  • Remote role (must reside in NJ, NY, PA, CT, or DE); strong SAS, R, and SQL experience

DOMAIN EXPERTISE

  • Pricing, analytics, and modeling for ACA, Medicare Advantage, and Medicaid
  • Supervisory experience managing data scientists and actuaries (7+ years)
  • Experience with clinical and claims data analytics and encounter submissions
  • Experience producing and signing actuarial forecasts, valuations, and filings

KEY REQUIREMENTS

  • Fellow of the Society of Actuaries (FSA) required
  • Minimum 10 years in healthcare/health insurance or insurance analytics
  • At least 7 years supervising data scientists and actuaries
  • Bachelor’s degree in math, statistics, actuarial science, or related field
  • Hands-on experience with clinical and claims data and SAS, R, and SQL

TECH STACK

  • Excel
  • PowerPoint
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Role Summary

Loading...

HIGHLIGHTS

Senior Health actuary (Sr. Director) leading risk adjustment analytics, predictive modeling, and encounter submission platforms for Commercial, Medicare Advantage, Medicaid and ACA lines. Responsible for end-to-end data, model development, regulatory submissions, and signing actuarial filings. Senior leadership role reporting to the VP of Medical Economics and Risk Adjustment. Remote role with required residence in certain Northeastern US states.

JOB DESCRIPTION SUMMARY

  • Lead enterprise risk adjustment data, analytics, modeling, and encounter submissions
  • Develop predictive models to optimize risk scores and measure coding/clinical accuracy
  • Oversee actuarial forecasts, valuations, and sign regulatory actuarial filings
  • Manage and mentor analytics and actuarial staff; 7+ years supervisory experience required
  • Remote role (must reside in NJ, NY, PA, CT, or DE); strong SAS, R, and SQL experience

DOMAIN EXPERTISE

  • Pricing, analytics, and modeling for ACA, Medicare Advantage, and Medicaid
  • Supervisory experience managing data scientists and actuaries (7+ years)
  • Experience with clinical and claims data analytics and encounter submissions
  • Experience producing and signing actuarial forecasts, valuations, and filings

KEY REQUIREMENTS

  • Fellow of the Society of Actuaries (FSA) required
  • Minimum 10 years in healthcare/health insurance or insurance analytics
  • At least 7 years supervising data scientists and actuaries
  • Bachelor’s degree in math, statistics, actuarial science, or related field
  • Hands-on experience with clinical and claims data and SAS, R, and SQL

TECH STACK

  • Excel
  • PowerPoint

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Job Overview

Salary
$191k - $266k
Years of Experience
10+ Years
Work Type
Permanent
Full Time

Ideal Candidate Profile

Senior FSA health actuary with deep experience in Medicare, Medicaid, and commercial risk adjustment who excels at leading analytics teams, building predictive models, and owning regulatory submissions.

FSA

Benefits

Health Insurance401(k) PlanGenerous VacationAnnual BonusWellness ProgramVolunteering ProgramTuition ReimbursementRemote First
Shortlist Forming
Closing Soon
52d
52 days ago

Strategy: Speed over Perfection

By Day 21, visibility drops significantly. Recruiters are focusing on existing candidates.

"Don't wait for a cover letter. The requisition could close tomorrow. Apply now."

Job Overview

Salary
$191k - $266k
Years of Experience
10+ Years
Work Type
Permanent
Full Time

Ideal Candidate Profile

Senior FSA health actuary with deep experience in Medicare, Medicaid, and commercial risk adjustment who excels at leading analytics teams, building predictive models, and owning regulatory submissions.

FSA

Benefits

Health Insurance401(k) PlanGenerous VacationAnnual BonusWellness ProgramVolunteering ProgramTuition ReimbursementRemote First
Shortlist Forming
Closing Soon
52d
52 days ago

Strategy: Speed over Perfection

By Day 21, visibility drops significantly. Recruiters are focusing on existing candidates.

"Don't wait for a cover letter. The requisition could close tomorrow. Apply now."

Health/Insurer/Director Level
Horizon Blue Cross Blue Shield of New Jersey

Sr. Director, Risk Adjustment Modeling Analytics & Submission

Horizon Blue Cross Blue Shield of New Jersey•Hopewell, NJ - Remote•1mo ago
RemoteCommercial Employer HealthMedicare AdvantageMedicaidACA ExchangePredictive Modelling & MLReserving & ValuationRegulatory Reporting