Actuarial Manager, Medicare Advantage Revue Analytics

Essential Job Functions

• Build upon existing processes to create standardized MA risk adjustment projection models
• Evaluate operational leading indicators and connection to actuarial projections
• Influence BOI (Burden of Illness)-based operational leading indicators
• Benchmark market performance and identify areas for opportunity
• Investigate differences in health plan risk adjustment coding practices using MAO-004 data
• Summarize YoY changes in MA bid rates/rebates and evaluate impact to agilon’s book of business
• Assess health plan MA bid strategies and partner with payer contracting/other stakeholders to mitigate risks
• Educate internal stakeholders on the health plan MA bidding process and risk adjustment where necessary to appropriately deliver results
• Provide actionable insights and recommendations to senior leadership based on actuarial analyses
• Collaborate with Payer Data Management to onboard new revenue-only MA payers in the FDP (Financial Data Pipeline)
• Prepare internal/external audit documentation
• Support build-out of improved actuarial team processes

Other Job Functions

• Grow and lead talent
• Exemplify companies’ core values
• Collaborate with Market Finance, FP&A, Accounting, Med Econ, and others

Required Qualifications

• 5+ years of actuarial experience related to the Medicare Advantage program
• Demonstrated leadership capability, has previously led others

Knowledge, Skills, and Abilities

• Excellent communication, both written and verbal
• Strong understanding of MA revenue components
• Understanding of MA health plan data (MMR, MAO-004, Claims etc.)
• Deep understanding of MA risk adjustment and bidding process
• Experience with value-based arrangements is a plus
• Proficiency with Excel and SQL
• Strong model building mindset; model flow, ease of use, auditability, etc.
• Proven ability to work in a fast-paced environment where internal/external client satisfaction is key
• Experience presenting actuarial/financial concepts to a non-technical audience
• Proven problem-solving skills (identification of issue, causes, solution, implementation plan)
• Proven ability to influence, grow, and motivate others
• Entrepreneurial and innovative spirit