Senior Actuarial Analyst

About the role

This role offers the opportunity to directly influence Medicare Advantage risk score optimization, revenue forecasting, and bid risk score development within a multi-provider-owned health plan. The role is focused on Medicare Advantage Risk Adjustment and will be instrumental in implementing and understanding the details of CMS Medicare risk score models, conducting analytical studies, and performing trend analysis and reporting.

Responsibilities

• Drive insights that directly impact Medicare Advantage revenue, bid development, and financial performance
• Lead development of monthly Medicare Advantage risk adjustment analytics, including open opportunities, suspecting insights, and risk score performance tracking
• Analyze Part C (HCC) and Part D (RxHCC) diagnosis data to inform bid pricing assumptions, including modeling impacts of risk model changes and coding improvement initiatives
• Refined and enhanced risk score projections throughout the bid cycle using emerging diagnosis data and claims runout
• Develop and maintain estimates for risk adjustment revenue, including initial, mid-year, and final payment projections to support financial reporting and forecasting
• Partner closely with Risk Adjustment, Compliance, and Analytics teams to drive strategy and optimize program performance
• Build, enhance, and maintain actuarial models supporting pricing, forecasting, and financial planning processes
• Perform advanced data analysis, trend evaluation, and scenario testing to quantify risk and inform strategic decision-making
• Identify opportunities to improve methodologies, automate processes, and increase model accuracy and efficiency
• Translate complex data into actionable insights and recommendations for business leaders
• Cross-functional collaboration & communication
• Collaborate with Product, Finance, Sales, and Provider Services to align actuarial insights with business strategy
• Clearly communicate technical findings to non-technical stakeholders, including senior leadership
• Develop dashboards, reports, and visualizations to monitor key performance indicators and support decision-making
• Pricing, Forecasting & Financial Support
• Contribute to and influence Medicare Advantage pricing strategies through risk score analytics and revenue cycle deep-dives
• Contribute to financial planning, forecasting, and budgeting processes by delivering accurate and timely actuarial analyses
• Conduct ad hoc analyses to evaluate emerging risks, financial performance, and strategic opportunities
• Regulatory & Professional Excellence
• Support bid filings, risk adjustment accrual analyses, and regulatory reporting requirements where applicable
• Ensure alignment with CMS and other regulatory guidelines impacting Medicare Advantage programs
• Stay current on industry trends, risk adjustment methodologies, and actuarial best practices
• Contribute to ongoing development of actuarial capabilities

Qualifications

• Bachelor’s Degree with 4 years of relevant experience
• Designated Associate of the Society of Actuaries (ASA) credential preferred, or passed a minimum of 3 ASA exams with a commitment toward obtaining ASA credential
• Experience with Medicare Advantage Risk Adjustment (HCC/RxHCC) or diagnosis-based modeling
• Actuarial experience in pricing, reserving, and/or other financial analysis
• Ability to file rates in compliance with state and federal regulations
• Advanced Excel skills and intermediate programming skills (SQL, SAS, R, Python, etc.)
• Experience in Microsoft PowerPoint to create storylines