Senior Actuary, Health Plan Analytics

Job not on LinkedIn

🔥 3 hours ago

🇺🇸 United States – Remote

💵 $150k - $185k / year

⏰ Full Time

🟠 Senior

📊 Actuary

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Reveleer

WebsiteLinkedInAll Job Openings

51 - 200 employees

🏥 Healthcare

⚕️ Healthcare Insurance

☁️ SaaS

Healthcare • Healthcare Insurance • SaaS

Reveleer is a healthcare technology company that specializes in providing an end-to-end platform for value-based care. Their platform leverages artificial intelligence to automate tasks, improve efficiency, and enhance patient care by consolidating risk adjustment and quality improvement workflows. Reveleer helps healthcare organizations streamline their operations through intelligent data acquisition, enhancing productivity and ensuring accurate reimbursement. With a focus on healthcare intelligence, Reveleer integrates with HIEs and EHR systems to improve care delivery and capture relevant diagnoses. They have a significant presence in the healthcare industry, working with various health plans to maximize their performance and patient outcomes.

📋 Description

• Build and maintain member-level actuarial models covering risk adjustment (RAF) performance, HCC capture and recapture, medical economics, utilization patterns, and population health metrics across MA, MAPD, ACA, and Medicaid populations. • Develop analytics that can support rate-setting for Medicare Advantage Bids, ACA rate filings, Medicaid capitation arrangements, and value-based contract terms. • Reconcile RAF calculations against source files, including the Monthly Membership Report (MMR), Model Output Report (MOR), MAO-004, and the Beneficiary-Level file, and extend that reconciliation logic into customer-facing reporting. • Design the actuarial and analytic logic behind customer-facing dashboards, partnering with data engineering and product teams to translate member-level models into usable, accurate, and timely visualizations. • Produce forecasting and accrual models that support midyear and final settlement estimates, transfer payments, capital planning, and financial reporting for risk adjustment programs. • Analyze utilization trends, medical loss ratio (MLR) drivers, and cost-of-care patterns to identify actionable opportunities for customers managing value-based contracts. • Support MA and HHS RADV (Risk Adjustment Data Validation) readiness by modeling audit exposure and prioritizing chart review and coding efforts based on financial impact. • Communicate model methodology, assumptions, and results clearly to actuarial and non-actuarial audiences, including customer executives. • Partner with clinical, coding, retrieval, and provider engagement teams to align analytic outputs with chronic HCC recapture, care gap closure, and quality initiatives.

🎯 Requirements

• Seven or more 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 the following: Medicare Advantage, MAPD, ACA, Medicaid, and value-based contracts. • Working knowledge of the CMS-HCC and ACA risk model, RAF score calculation, and the relationship between ICD-10 diagnosis coding and risk adjustment revenue. • Demonstrated 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, such as SAS, R, or Python. • Proficiency in utilizing AI tools to support modeling • Bachelor's degree in actuarial science, mathematics, statistics, economics, or a related quantitative field. • Strong written and verbal communication skills, with experience presenting actuarial findings to executive audiences.

🏖️ Benefits

• Competitive salary • Medical, Dental and Vision benefits • 401k match • Generous PTO plan