Actuarial Director
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
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