Reveleer

22 hours ago

Director of Actuarial Analytics and Insights

✓ Verified Job

Canonical indexed version, validated from employer's careers page.

Source: Company careers pageValidated by: Fursa AI

Last checked: 8 hours agoStatus: Live

Job Summary

Lead member-level actuarial analytics for health plan and risk adjustment programs across Medicare Advantage, MAPD, ACA, Medicaid, and value-based contracts. Build and maintain risk adjustment (RAF), HCC capture/recapture, medical economics, utilization, and population health models, then translate them into customer-facing dashboards for pricing, forecasting, and program strategy. Partner with analytics, product, operations, and clinical teams while reconciling CMS inputs and supporting RADV readiness.

Location: United States

Workplace: Remote

Employment Type: Full time

Job Function: Insurance & Actuarial

Seniority: Director level

Key Responsibilities

•Build and maintain member-level actuarial models for RAF performance, HCC capture/recapture, medical economics, utilization patterns, and population health metrics across MA, MAPD, ACA, and Medicaid.
•Develop analytics to support rate-setting and financial arrangements, including Medicare Advantage bids, ACA rate filings, Medicaid capitation, and value-based contract terms.
•Reconcile RAF calculations against source files (MMR, MOR, MAO-004, Beneficiary-Level) and extend reconciliation into customer-facing reporting.
•Design analytic logic behind customer-facing dashboards with data engineering and product partners to deliver accurate, timely visualizations.
•Create forecasting and accrual models for settlement estimates and payments; analyze MLR and cost-of-care drivers; support RADV readiness and communicate results to technical and non-technical audiences.

Pay and Benefits

Salary: USD 150,000 - 185,000

Perks:Health InsuranceDentalVision401kPaid 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 ICD-10 diagnosis coding-to-risk-adjustment relationship.
•Experience building member-level data models that feed reporting or dashboard tools such as Tableau or Power BI.
•Proficiency in SQL and at least one statistical or scripting language (SAS, R, or Python), plus strong written and verbal communication for executive audiences.

Experience:Health plan pricingRisk adjustmentMedical economicsMedicare AdvantageACA/Medicaid

Education:Bachelor's in actuarial science, mathematics, statistics, economics, or a related quantitative field

Skills:CommunicationExecutive communicationProblem-solvingStakeholder communication

Tech Stack:SASSQLTableauMicrosoft ExcelRRStudioPythonMicrosoft AccessMicrosoft Visual Basic (VBA)

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

Glassdoor: 4.2

Website LinkedIn Glassdoor

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Reveleer

22 hours ago

Director of Actuarial Analytics and Insights

✓ Verified Job

Canonical indexed version, validated from employer's careers page.

Source: Company careers pageValidated by: Fursa AI

Last checked: 8 hours agoStatus: Live

Job Summary

Location: United States

Workplace: Remote

Employment Type: Full time

Job Function: Insurance & Actuarial

Seniority: Director level

Key Responsibilities

•Build and maintain member-level actuarial models for RAF performance, HCC capture/recapture, medical economics, utilization patterns, and population health metrics across MA, MAPD, ACA, and Medicaid.
•Develop analytics to support rate-setting and financial arrangements, including Medicare Advantage bids, ACA rate filings, Medicaid capitation, and value-based contract terms.
•Reconcile RAF calculations against source files (MMR, MOR, MAO-004, Beneficiary-Level) and extend reconciliation into customer-facing reporting.
•Design analytic logic behind customer-facing dashboards with data engineering and product partners to deliver accurate, timely visualizations.
•Create forecasting and accrual models for settlement estimates and payments; analyze MLR and cost-of-care drivers; support RADV readiness and communicate results to technical and non-technical audiences.

Pay and Benefits

Salary: USD 150,000 - 185,000

Perks:Health InsuranceDentalVision401kPaid 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 ICD-10 diagnosis coding-to-risk-adjustment relationship.
•Experience building member-level data models that feed reporting or dashboard tools such as Tableau or Power BI.
•Proficiency in SQL and at least one statistical or scripting language (SAS, R, or Python), plus strong written and verbal communication for executive audiences.

Experience:Health plan pricingRisk adjustmentMedical economicsMedicare AdvantageACA/Medicaid

Education:Bachelor's in actuarial science, mathematics, statistics, economics, or a related quantitative field

Skills:CommunicationExecutive communicationProblem-solvingStakeholder communication

Tech Stack:SASSQLTableauMicrosoft ExcelRRStudioPythonMicrosoft AccessMicrosoft Visual Basic (VBA)

Company Brief

Reveleer

Industry: HealthTech

Company Size: Large (251 to 1,000 employees)

Growth: Scaleup

Funding: Private Equity Backed

Headquarters: Glendale, United States

Founded: 2009

Glassdoor: 4.2

Website LinkedIn Glassdoor