Senior Actuarial Analyst - Medicare Advantage
A growing healthcare organization is seeking a Senior Actuarial Analyst to support financial strategy and performance across its Medicare Advantage business. This role will serve as a key partner to leadership by delivering actionable insights, enhancing forecasting capabilities, and strengthening financial visibility across core operations.
The position offers a blend of actuarial modeling, financial analysis, and cross-functional collaboration, with a strong emphasis on revenue optimization and business performance monitoring.
Key Responsibilities
Revenue & Risk Adjustment Analytics
- Build and refine models to estimate risk-adjusted revenue across Medicare Advantage populations
- Analyze risk score performance, coding completeness, and underlying drivers of RAF variability
- Assess the financial implications of regulatory changes, including updates to CMS risk adjustment methodologies
- Partner with internal stakeholders to evaluate revenue impacts tied to operational initiatives, membership changes, and clinical programs
- Contribute to budgeting cycles, forecasting updates, and variance analysis tied to revenue performance
Forecasting & Financial Modeling
- Develop forward-looking projections for medical cost and revenue to support planning and decision-making
- Align modeling assumptions with business strategy through collaboration with clinical, operational, and finance leaders
- Deliver financial reporting packages and summarize key insights for leadership audiences
- Support strategic analyses, investment decisions, and enterprise initiatives through ad hoc modeling
Reserving & Financial Close Support
- Assist in estimating and monitoring reserves, including IBNR development and evaluation
- Contribute to monthly close processes through reporting, reconciliation, and variance explanation
- Maintain consistency and accuracy across financial datasets used in reporting cycles
Data & Performance Analysis
- Analyze healthcare data (e.g., claims, utilization, cost trends) to identify performance drivers and improvement opportunities
- Perform data validation, reconciliation, and integration across multiple internal and external sources
- Act as a liaison for data-related inquiries, working with external payors and internal stakeholders as needed
Operational & Business Insights
- Track key financial and operational indicators to assess organizational performance
- Identify inefficiencies and recommend actions to improve financial outcomes and mitigate risk
- Evaluate the economic impact and effectiveness of clinical programs, population health initiatives, and care models
- Support the development of dashboards and reporting tools to improve visibility into KPIs
Cross-Functional Collaboration
- Partner with teams across finance, accounting, operations, and technology to improve data flows and reporting accuracy
- Communicate analytical findings clearly to both technical and non-technical stakeholders
- Contribute to process improvement initiatives to enhance scalability and efficiency
Qualifications
- Bachelor's degree in Actuarial Science, Mathematics, Statistics, Economics, or a related quantitative field
- 3-6+ years of actuarial experience in healthcare, with exposure to Medicare Advantage strongly preferred
- Progress toward actuarial credentials (ASA or pre-ASA with multiple exams completed)
- Strong understanding of CMS risk adjustment frameworks and RAF score mechanics
- Experience working with financial statements, forecasting models, and large healthcare datasets
Technical Skills
- Advanced Excel proficiency for modeling and analysis
- Experience with SQL or similar tools for data extraction and manipulation
- Familiarity with actuarial modeling, forecasting techniques, and variance analysis
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