Senior Actuarial Analyst

Overview

We are seeking a
Senior Actuarial Analyst to drive Medicare Advantage risk adjustment initiatives and financial outcomes s role offers the opportunity to directly influence Medicare Advantage risk score optimization, revenue forecasting, and bid risk score development within a multi-provider-owned health plan.

This role is focused on Medicare Advantage Risk Adjustment and will be instrumental in implementing and understanding the details of CMS Medicare risk score models, conducting analytical studies, and performing trend analysis and reporting. You will apply your actuarial expertise to support pricing, forecasting, and reserving activities, while also contributing to key corporate initiatives. As a senior member of the team, you will lead analytical work efforts, ensure accuracy in bid development and filings, and provide guidance that supports sustainable growth and financial stability.

• Direct exposure and engagement with department leadership, offering visibility and influence on strategic initiatives

• Supportive, collaborative team environment with a clear path for career growth and advancement

• Comprehensive Actuarial Study Program to support continued credentialing and professional development

• Opportunity to work on high-impact Medicare Advantage risk adjustment initiatives within a multi-provider owned health plan, gaining insight into diverse provider coding practices

• Autonomy to lead and own analyses, including modeling and evaluating impacts for CMS Medicare Advantage Part C (HCC) and Part D (RxHCC) risk adjustment programs

• Starting salary is based upon skills and experience: $98,900 - $134,400 plus robust benefits package

Medicare Advantage Risk Adjustment:

• Drive insights that directly impact Medicare Advantage revenue, bid development, and financial performance

• Lead development of monthly Medicare Advantage risk adjustment analytics, including open opportunities, suspecting insights, and risk score performance tracking

• Analyze Part C (HCC) and Part D (RxHCC) diagnosis data to inform bid pricing assumptions, including modeling impacts of risk model changes and coding improvement initiatives

• Refine and enhance risk score projections throughout the bid cycle using emerging diagnosis data and claims runout

• Develop and maintain estimates for risk adjustment revenue, including initial, mid-year, and final payment projections to support financial reporting and forecasting

• Partner closely with Risk Adjustment, Compliance, and Analytics teams to drive strategy and optimize program performance

Actuarial Modeling & Analytics:

• Build, enhance, and maintain actuarial models supporting pricing, forecasting, and financial planning processes

• Perform advanced data analysis, trend evaluation, and scenario testing to quantify risk and inform strategic decision-making

• Identify opportunities to improve methodologies, automate processes, and increase model accuracy and efficiency

• Translate complex data into actionable insights and recommendations for business leaders

Cross-Functional Collaboration & Communication:

• Collaborate with Product, Finance, Sales, and Provider Services to align actuarial insights with business strategy

• Clearly communicate technical findings to non-technical stakeholders, including senior leadership

• Develop dashboards, reports, and visualizations to monitor key performance indicators and support decision-making

Pricing, Forecasting & Financial Support:

• Contribute to and influence Medicare Advantage pricing strategies through risk score analytics and revenue cycle deep-dives

• Contribute to financial planning, forecasting, and budgeting processes by delivering accurate and timely actuarial analyses

• Conduct ad hoc analyses to evaluate emerging risks, financial performance, and strategic opportunities

Regulatory & Professional Excellence:

• Support bid filings, risk adjustment accrual analyses, and regulatory reporting requirements where applicable

• Ensure alignment with CMS and other regulatory guidelines impacting Medicare Advantage programs

• Stay current on industry trends, risk adjustment methodologies, and actuarial best practices

• Continue progression toward actuarial credentials…