Actuary

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Accrues PDO
• Wilmington, NC, US

Requisition

Since 1971, Wilmington Health has been committed to the care and health of our community in Wilmington and all of Southeastern North Carolina. Wilmington Health is a multi-specialty medical practice with primary care providers integrated into the system to provide a comprehensive and coordinated approach to care. The organization uses collaborative, evidence-based medicine to deliver high-quality care.

The Actuary will own actuarial, financial, and analytical work related to healthcare value-based care arrangements, including ACOs, Medicare, Medicaid, Medicare Advantage, commercial risk contracts, and other population health programs. This is a credentialed actuarial role requiring an ASA (or higher) designation and independent actuarial judgment, with accountability for the soundness of one s work product.

This position analyzes healthcare claims, utilization, cost trends, risk adjustment, attribution, benchmarks, shared savings/loss opportunities, and performance under value-based care models. The Actuary collaborates with finance, analytics, operations, clinical leadership, contracting, and executive stakeholders to identify financial opportunities, evaluate risk, support strategic decisions, and communicate complex actuarial concepts clearly.

The role requires strong technical skills, healthcare data experience, and the ability to independently conduct actuarial analysis in accordance with applicable Actuarial Standards of Practice (ASOPs) and the Code of Professional Conduct. The role carries professional responsibility for its own actuarial conclusions.

• Analyze medical claims, eligibility, attribution, provider, quality, and financial data to support value-based care performance evaluation.
• Develop and maintain actuarial models for total cost of care, medical expense trends, utilization, unit cost, risk adjustment, benchmark performance, and shared savings/loss projections across Medicare Shared Savings Program, ACO REACH, Medicare Advantage, Medicaid, commercial risk, and other value-based care arrangements.
• Quantify the impact of changes in population, attribution, risk scores, benchmarks, rates, utilization, and medical cost trends.
• Evaluate performance by provider group, cohort, market, payor, contract, service line, diagnosis category, site of care, and other relevant segments.
• Identify medical cost and utilization opportunities, including avoidable admissions, emergency department utilization, post-acute care, specialist spend, pharmacy trends, chronic condition management, and care gap opportunities.
• Lead opportunity analyses for prospective partners, participants, or markets entering value-based care arrangements.
• Prepare financial forecasts, scenario analyses, sensitivity analyses, and performance projections to inform leadership decisions.
• Lead the financial evaluation of value-based care arrangements, including shared savings terms, downside risk exposure, benchmark assumptions, stop-loss considerations, and administrative fee structures.
• Monitor ongoing performance against budget, benchmark, expected trend, and contractual targets.
• Support reconciliation analysis for value-based care programs, including earned savings, losses, quality adjustments, risk score changes, attribution changes, and benchmark updates.
• Analyze risk adjustment data, including HCC/RAF trends, coding patterns, demographic factors, disease burden, and documentation opportunities.
• Develop reports, dashboards, and executive summaries that translate actuarial findings into clear business insights for clinical, operational, financial, and executive audiences.
• Partner with analytics, IT, finance, operations, clinical, and business leaders to define data needs, gather requirements, validate assumptions, and communicate findings.
• Contribute to the development and maintenance of actuarial data structures, reporting processes, and repeatable analytical tools.
• Communicate trends, issues, risks, and opportunities to management and proactively recommend next steps.
• Support special projects requiring actuarial research, healthcare financial analysis, market analysis, or value-based care modeling.
• Maintain a working knowledge of healthcare regulations, CMS programs, payor methodologies, value-based care models, risk adjustment, claims data, and reimbursement structures.
• Continuously assess existing analytical processes and recommend improvements to increase accuracy, efficiency, scalability, and usefulness of reporting.
• Develop and maintain internal actuarial methodologies, documentation, and assumptions, consistent with professional actuarial standards.
• Serve as an informal mentor to junior analysts, interns, or team members on actuarial methods, healthcare data, and analytical best practices.
• Perform other healthcare…