Consulting Actuary - ACA Risk Adjustment

About the role

As a Consulting Actuary - ACA Risk Adjustment, you will play a pivotal role in delivering a wide array of actuarial and analytical services for our organization. You will lead pricing strategies and actuarial initiatives, evaluate advanced care management models, conduct competitive benchmarking analyses, and design and price sophisticated insurance products. This position requires adaptability to the evolving industry landscape, ensuring our actuarial practices remain at the forefront of innovation and excellence.

Responsibilities

• Accountable for completion of complex actuarial or analytical projects, ensuring timeliness, compliance, and quality of work
• Provide proactive and strategic thought leadership to improve processes, reduce risks, and meet department and enterprise objectives for profitable growth and improved value, quality, and access for customers
• Achieve segment financial targets and provide concise explanations of results and variances to expectations; act as a financial steward for the company
• Communicate effectively with all levels and divisions within the organization, including Divisional Leadership
• Manage external partnerships with vendors, auditors, regulators, and health care providers, including effective negotiation of contracts and/or rates
• Develop and maintain strong business relationships with internal partners through business expertise and exceptional support; act as a strategic advisor
• Meet continuing education standards required for job function, thought leadership, and maintenance of actuarial credentials

Requirements

• Bachelor's degree or advanced degree (where required)
• Member of the American Academy of Actuaries
• Fellow of the Society of Actuaries (FSA) with 7 years of relevant actuarial experience, or Associate of the Society of Actuaries (ASA) with at least 9 years of relevant actuarial experience

Skills

• Actuarial Analysis
• Actuarial Management
• Actuarial Science
• Actuarial Services
• Affordable Care Act (ACA)
• Complex Care Management
• Financial Reporting and Analysis
• Hiring Management
• Insurance Industry
• Organizational Leadership
• Regulatory Compliance

Bonus Points

• Deep experience with ACA Risk Adjustment, including HHS-HCC model methodology, risk score forecasting, and financial impact analysis (Highly Preferred)
• Proven expertise in ACA Risk Adjustment transfer forecasting and explanation of results to senior leadership (Highly Preferred)
• Strong understanding of diagnosis coding (ICD-10-CM), provider documentation practices, and their impact on risk adjustment outcomes
• Advanced analytical skills to identify risk adjustment leakage, emerging risks, and optimization opportunities across ACA populations

Benefits

• Medical, dental, and vision coverage along with numerous health and wellness programs
• Parental leave and support plus adoption and surrogacy assistance
• Career development programs and tuition reimbursement for continued education
• 401k match including an annual company contribution
• Work-life balance, flexibility, and autonomy

Pay

Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus (based on annual corporate goal achievement and individual performance), 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs. Starting salaries are typically planned near the middle of the range listed.

$143,616.00 - $229,786.00