Senior Actuary, Health Plan Analytics

Reveleer
United States
Workplace: RemoteFull timeUSD 150,000 - 185,000 annuallyFunction: Data Analytics & Business IntelligenceExperience: 7+ yearsEducation: bachelorsSkills: ["Written communication","Verbal communication","Executive communication","Explain complex concepts"]

Lead health plan and risk adjustment analytics by building member-level actuarial models across Medicare Advantage, MAPD, ACA, and Medicaid. Reconcile RAF calculations against CMS files, design the analytic logic behind customer-facing dashboards, and develop forecasting and accrual models for settlements and reporting. Partner with customer success, analytics, product, operations, and clinical teams to turn claims and encounter data into decision-ready outputs, including RADV readiness support and executive communication.

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Reveleer
Reveleer
1 month ago

Senior Actuary, Health Plan Analytics

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Last checked: 18 minutes agoStatus: Live

Job Summary

Lead health plan and risk adjustment analytics by building member-level actuarial models across Medicare Advantage, MAPD, ACA, and Medicaid. Reconcile RAF calculations against CMS files, design the analytic logic behind customer-facing dashboards, and develop forecasting and accrual models for settlements and reporting. Partner with customer success, analytics, product, operations, and clinical teams to turn claims and encounter data into decision-ready outputs, including RADV readiness support and executive communication.
Location: United States
Workplace: Remote
Employment Type: Full time
Job Function: Data Analytics & Business Intelligence
Seniority: Mid level

Key Responsibilities

  • •Build and maintain member-level actuarial models for RAF performance, HCC capture/recapture, medical economics, utilization, and population health across MA, MAPD, ACA, and Medicaid.
  • •Develop analytics to support rate-setting for Medicare Advantage bids, ACA rate filings, Medicaid capitation arrangements, and value-based contract terms.
  • •Reconcile RAF calculations against CMS source files (MMR, MOR, MAO-004, Beneficiary-Level) and extend reconciliation into customer-facing reporting.
  • •Design actuarial and analytic logic behind customer-facing dashboards in partnership with data engineering and product teams.
  • •Produce forecasting and accrual models for midyear/final settlement estimates, transfer payments, capital planning, and risk adjustment financial reporting; support RADV readiness and prioritize chart review/coding based on financial impact.

Pay and Benefits

Salary: USD 150,000 - 185,000 annually
Perks:MedicalDentalVision401kPaid Leave

Key Requirements

  • •7+ years of actuarial or actuarial-adjacent analytics experience in health plan pricing, risk adjustment, or medical economics.
  • •Direct pricing or performance modeling experience across at least three of Medicare Advantage, MAPD, ACA, Medicaid, and value-based contracts.
  • •Working knowledge of the CMS-HCC and ACA risk model, RAF score calculation, and the link between ICD-10 diagnosis coding and risk adjustment revenue.
  • •Experience building member-level data models feeding reporting or dashboard tools such as Tableau or Power BI.
  • •Proficiency in SQL and at least one statistical or scripting language such as SAS, R, or Python.
Experience:7+ yearsHealth plan pricingRisk adjustmentMedical economicsMedicare AdvantageACAMedicaidValue-based contracts
Education:Bachelor's in actuarial science, mathematics, statistics, economics, or a related quantitative field
Skills:Written communicationVerbal communicationExecutive communicationExplain complex concepts
Certifications:ASAFSA
Tech Stack:SASSQLTableauPower BIPythonRRStudioMicrosoft ExcelMicrosoft AccessMicrosoft Visual BasicAI toolsSAS (Enterprise Guide)

Company Brief

Reveleer
Provides an AI-powered value-based care platform for health plans and risk-bearing providers, offering retrieval, clinical intelligence, risk adjustment, quality improvement, and member management solutions to streamline workflows and improve outcomes.
Industry: HealthTech
Company Size: Large (251 to 1,000 employees)
Growth: Scaleup
Funding: Private Equity Backed
Headquarters: Glendale, United States
Founded: 2009
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