Lead Actuarial Analyst, MA Risk Adjustment

What You'll Do

• Translate RA performance data into clear financial insights (i.e. revenue impact, payment accuracy, ROI, forecasting).
• Analyze CMS data to identify areas of opportunity to increase operational efficiency.
• Interpret trends, model scenarios, and assess program and policy impacts.
• Enable data-driven decisions by linking operational performance to enterprise financial outcomes.
• Perform end-to-end reconciliation from submissions to CMS acceptance, RAF leakage, and implement controls.
• Develop business cases to assess opportunity, determine target metrics, and provide data driven insights to support investment decisions (i.e. staffing, tech, etc.).
• Prepare and deliver clear and concise reports, presentations, and recommendations to senior leadership, illustrating the findings and implications of analyses conducted.

Who You Are

• A highly analytical problem-solver with a strong sense of ownership and intellectual curiosity.
• Able to manage a high volume of recurring and ad hoc deliverables without compromising quality.
• Comfortable navigating ambiguity and bringing structure to complex problems.
• An exceptional communicator who can translate technical findings into actionable business recommendations.

Qualifications

• 4+ years of experience in risk adjustment analytics.
• 4+ years of experience analyzing MMR, MOR, MAO-004 and medical claims data.
• 3+ actuarial exams passed.
• High degree of proficiency in Microsoft Excel and SQL.
• Experience with PBI, Redshift, dbt docs is a plus.
• Bachelor’s degree in a quantitative or health-related field (e.g., Economics, Public Health, Statistics, Health Services Research, Math, Finance).

Pay

Annual Salary Range: $99,000 - $124,000.

This position is also eligible for a target annual bonus of 10%.

Final compensation will be determined based on location, experience, and qualifications.