Senior Actuary, Health Plan Analytics

Accountabilities: The Senior Actuary, Health Plan Analytics will be responsible for developing actuarial models, translating healthcare data into strategic insights, and supporting customers with analytics-driven recommendations. The role requires strong collaboration across business and technical teams to deliver accurate, scalable, and impactful solutions.

Build and maintain member-level actuarial models focused on risk adjustment performance, HCC capture and recapture, medical economics, utilization trends, and population health metrics across Medicare Advantage, MAPD, ACA, Medicaid, and value-based care programs.

Develop analytics supporting pricing strategies, Medicare Advantage bids, ACA rate filings, Medicaid capitation arrangements, and value-based contract decisions.

Reconcile risk adjustment calculations using key healthcare data sources and extend analytical logic into customer-facing dashboards and reporting solutions.

Partner with data engineering and product teams to design actuarial methodologies and translate complex models into accurate, user-friendly visualizations.

Create forecasting and accrual models supporting financial planning, settlement estimates, transfer payments, and risk adjustment program reporting.

Analyze utilization trends, medical loss ratio drivers, and cost-of-care patterns to identify opportunities for healthcare improvement and financial optimization.

Support audit readiness initiatives by modeling risk exposure and prioritizing high-impact chart review and coding activities.

Communicate actuarial methodologies, assumptions, and findings clearly to both technical and non-technical audiences, including healthcare executives.

Collaborate with clinical, coding, retrieval, and provider engagement teams to support quality improvement and risk adjustment strategies.

Leverage AI tools and emerging technologies to enhance actuarial modeling, analytics processes, and decision-making capabilities.

Requirements:

The ideal candidate brings extensive actuarial and healthcare analytics experience, with a strong understanding of health plan economics, risk adjustment methodologies, and data-driven decision-making. They should combine technical modeling expertise with the ability to communicate insights effectively to business stakeholders.

7+ years of actuarial or actuarial-adjacent analytics experience in health plan pricing, risk adjustment, medical economics, or related healthcare analytics fields.

Proven experience modeling performance across multiple healthcare markets, including at least three of the following: Medicare Advantage, MAPD, ACA, Medicaid, and value-based contracts.

Strong understanding of CMS-HCC and ACA risk models, RAF calculations, ICD-10 diagnosis coding, and risk adjustment revenue concepts.

Experience building member-level data models that support reporting, analytics platforms, or dashboards such as Tableau or Power BI.

Proficiency in SQL and experience with statistical or scripting languages such as SAS, R, or Python.

Familiarity with healthcare data sources including MMR, MOR, MAO-004, Beneficiary-Level files, EDPS, and EDGE encounter submissions is preferred.

Experience supporting RADV or IVA audit readiness, chart review prioritization, or risk adjustment compliance initiatives is a plus.

Bachelor’s degree in actuarial science, mathematics, statistics, economics, or another quantitative discipline.

ASA, FSA designation, or active progress toward actuarial certification is preferred.

Strong written and verbal communication skills, with the ability to present complex actuarial findings to executive audiences.

Advanced analytical skills, attention to detail, and the ability to manage complex projects independently.

Benefits:

Competitive salary range of $150,000 – $185,000 , depending on experience, skills, and location.

Medical, dental, and vision insurance coverage.

401(k) retirement plan with employer matching contributions.

Generous paid time off (PTO) program.

Fully remote work opportunity.

Opportunity to work on impactful healthcare analytics initiatives using modern technology and AI-enabled solutions.

Collaborative environment with opportunities for professional growth and development.

How Jobgether works: We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best!  Why Apply Through Jobgether? 

Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.

#LI-CL1