Actuarial Manager, Medicare Value- Care

AHI agilon health, inc.

Remote - USA

Actuarial Manager, Medicare Value-Based Care

agilon health partners with primary care physicians to transform how care is delivered to seniors, taking on full-risk, total-cost-of-care arrangements. The actuarial team's work sits at the center of that model.

The Actuarial Manager, Medicare Value-Based Care is a senior individual contributor on the Markets actuarial team who will own the monthly results process for agilon's ACO REACH/ACO LEAD and MSSP populations, support payer settlement reconciliations, and produce supplemental exhibits for the month-end close. Operating in a consulting-style capacity, the Manager will also deliver high-priority analyses and project work, both individually and leading analysts from across the team, without direct people-management responsibility

This role is ideal for an experienced actuary who enjoys variety: roughly 40% of time is dedicated to CMS value-based program results, 40% to ad hoc projects and analyst coaching, and the remaining 20% to annual payer financial settlement work and select MA close deliverables. The Manager will also help incorporate AI support into the team's processes and co-lead project management across the actuarial organization

This is a fully remote position with minimal required travel

Director for the Markets Actuarial team. The role carries strong visibility with senior leaders across the organization, and the breadth of ownership is designed to build toward future leadership opportunities on the actuarial team

Own the end-to-end monthly results process: coordinate membership and revenue data intake from partner teams, run the retrospective trend adjustment (RTA) model, and oversee claims reserving and projection process

• ~ Guide the team through the CMS transition from ACO REACH to ACO LEAD: partner with the Central actuarial team (tools/methodology) on new requirements, and the VP of Direct Contracting on strategy
• ~ Consolidate results into clear summaries and lead the monthly results presentation to the Regional CFOs on the Market Finance team

• ~ Review payer contract terms to establish how final settlements should be calculated
• ~ Reconcile payer settlement calculations against contract terms and underlying claims and revenue data;
  Represent the finance organization directly with payer counterparts in a polished and professional manner to raise questions and request the detail needed for our review

• ~ Quantify and present drivers of claims prior period development, separating natural month-over-month runout from methodology updates and other one-time considerations

• ~ Lead project intake, prioritization, and progress tracking across the actuarial team
• ~ Lead high-priority ad hoc analyses end-to-end, flexing across markets and topics based on team needs
• ~ Coach and mentor analysts through project work, providing technical direction and review to expand team capacity and enhance the quality of the work product
• ~ Represent actuarial leadership in cross-functional forums and working groups, carrying decisions back to the actuarial team and ensuring completion of takeaway deliverables

• ~ Apply AI tools to claims analysis, automation of financial reporting, enablement of strategic decision-making, and review of payor contracts and financial statements
• ~ Support build-out of improved actuarial team processes

• ~ Collaborate with Market Finance, FP&A, Accounting, Medical Economics, Payer Contracting, and Regional Presidents
• ~ Identify critical issues and recommend solutions to business problems

~ 6+ years of actuarial experience (8+ years preferred)

~ Demonstrated leadership via project ownership and cross-functional initiatives, mentoring analysts, serving as a trusted delegate for a senior leader, and/or prior people management

Bachelor's degree

Excellent ability to communicate and present a financial narrative, both written and verbal

• ~ Strong understanding of Medicare Advantage and Value-Based Care concepts; experience with other CMS value-based arrangements (ACO REACH or MSSP) is a plus
• ~…