Seeking a highly skilled Actuary with a focus is Medicare Advantage Risk Adjustment.This role is ideal for a strategic thinker who is deeply technical, detail‑oriented, and thrives in a fast‑paced, data‑rich environment.
Key Responsibilities
• Medicare Advantage Financial Reporting & Revenue Modeling
• Lead actuarial financial reporting for Medicare Advantage and full‑risk provider groups.
• Analyze Monthly Membership Report (MMR) data to evaluate revenue trends and expected payments.
• Develop models to project accrual-based revenue, including considerations for:
• Mid-year and final risk score trends
• Membership shifts
• CMS payment changes
• Produce executive-level insights on revenue performance, drivers, and variances.
• Partner with finance and operations to support budget planning and forecasting cycles.
• RAF Forecasting & Actuarial Modeling
• Build and maintain actuarial models to forecast Risk Adjustment Factor (RAF) at member, cohort, and population levels.
• Provide scenario modeling and sensitivity analyses to predict RAF outcomes under multiple operational strategies.
• Support coding, clinical, and operations teams by quantifying the financial impact of interventions.
• CMS File Processing & Analytic Readiness
• Lead ingestion and transformation of CMS and payer data files for reporting and analytics use.
• Write optimized SQL code to create analytic-ready tables, ensuring accuracy, traceability, and compliance with CMS formats.
• Collaborate with data engineering teams to validate data quality and maintain controlled production workflows.
Required Qualifications
• ASA or FSA credential (or equivalent actuarial experience).
• 7+ years of actuarial experience with a focus on Medicare Advantage risk adjustment.
• Deep expertise with CMS risk adjustment models, payment methodology, and file structures.
• Advanced SQL skills-capable of writing complex queries, building pipelines, and transforming large datasets.
• Strong understanding of actuarial forecasting methods and predictive modeling.
• Proven ability to translate complex analysis into executive-ready insights.
• Experience collaborating cross-functionally with operations, clinical, data engineering, and finance.
Key Competencies
• Strategic decision-making and analytical rigor
• Technical depth in actuarial modeling and SQL
• Strong communication and stakeholder alignment
• Ability to operate both at a high-level and in detailed technical work
• Continuous improvement mindset and passion for innovation
Desired Skills and Experience
Risk Adjustment
Medicare Advantage
SQL
Data Modeling
Raw Data
FSA
ASA
Actuarial
RAF
HCC
MMR
Power Bi