Actuarial Director, Risk Adjustment
Actuarial Director, Risk Adjustment (Remote)
A leading healthcare organization is seeking am Actuarial Director, Risk Adjustment to guide a high‑performing team focused on improving the accuracy, performance, and financial impact of risk and quality programs across Medicare, Medicaid, and ACA lines of business.
This position plays a key role in shaping how the organization understands member risk, identifies improvement opportunities, and enhances care quality - directly influencing financial accuracy and member outcomes.
Responsibilities:
- End‑to‑end risk score modeling, forecasting, and trend analysis
- Coding gap identification, benchmarking, and opportunity targeting
- Evaluation of in‑home assessments, chart review, and point‑of‑care initiatives
- Development of dashboards and reporting that translate analytics into action
- Financial impact modeling to support budgeting, pricing, and forecasting
- Collaboration with provider teams to assess and improve performance
- Support for regulatory and internal audits (RADV, OIG, etc.)
- Leadership of a growing analytics team, including coaching, hiring, and performance management
Qualifications:
- 8+ years of relevant actuarial & analytics experience, including 3+ years managing people
- Strong risk adjustment experience (Medicare required)
- ASA/FSA designation
- Expertise in statistical methods, modeling, and performance measurement
- Proficiency with SAS and/or cloud analytics tools; strong database skills
- Ability to break down complex problems, validate data, and drive insights
- Clear, confident communication with executive‑level stakeholders
- Strength leading in a fast‑moving, matrixed environment
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