Actuary – CMS Regulatory, Bid Pricing

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Curana Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

🤝 B2B

⚕️ Healthcare Insurance

Healthcare • B2B • Healthcare Insurance

Curana Health is a healthcare provider focused on senior primary care and on-site clinical services in skilled nursing and senior living communities. The company partners with operators, payors, and Medicare Advantage plans to implement value-based care models, offering physician-led care teams, medical director services, care coordination (including RPM and APCM), behavioral health, and palliative care. Curana emphasizes reducing hospital readmissions, falls, and polypharmacy while improving resident satisfaction through integrated, community-based care supported by technology and payor partnerships.

📋 Description

• Lead CMS bid development and HPMS filings for Medicare Advantage plan years • Build and maintain IBNR reserve modeling and support monthly close and financial reporting cycles • Perform risk adjustment modeling, HCC analysis, and CMS payment reconciliation • Monitor and respond to CMS data systems including HPMS, MARx, and RAPS/EDPS • Support RADV audit preparation and encounter data quality review • Develop and maintain Part D pricing models and support reconciliation processes • Translate actuarial findings into clear, actionable insights for non-actuarial stakeholders • Partner cross-functionally with finance, clinical, compliance, and network teams • Manage multiple deliverables across competing deadlines, including bid season and CMS filing cycles • Support or lead the CMS bid submission cycle • Deliver accurate, actionable insights from risk and financial modeling • Strengthen reserve modeling and reporting processes • Provide clear, executive-ready recommendations

🎯 Requirements

• Bachelor's degree in Actuarial Science, Mathematics, Statistics, or related quantitative field • ASA (Associate of the Society of Actuaries) required • 5–8+ years of actuarial experience • Minimum 2 years of Medicare Advantage health plan experience required • Strong preference for healthcare or managed care experience • Hands-on experience with CMS bid development and HPMS submissions • Experience with risk adjustment modeling, HCC analysis, and CMS payment reconciliation • Advanced proficiency in Excel and actuarial modeling tools • Experience using SAS, R, Python, or SQL to analyze large healthcare datasets • Experience working with CMS data systems including HPMS, MARx, and RAPS/EDPS • FSA and/or MAAA designation preferred • Experience with ISNP, D-SNP, or dual-eligible populations preferred • Part D pricing and/or reconciliation experience preferred • Exposure to RADV audits and encounter data processes preferred • Must be able to work in the United States; visa sponsorship is unavailable

🏖️ Benefits

• Equal Employment Opportunity commitment and nondiscrimination policy • No visa sponsorship available (H1B or otherwise)