Actuary, CMS Regulatory & Bid Pricing

🕒 August 5

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

📊 Actuary

👻 Ghost score 33%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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 models 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, with a strong preference for healthcare or managed care settings • Minimum 2 years of Medicare Advantage health plan experience required • 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 not require visa sponsorship; the company is unable to provide sponsorship for a visa at this time

🏖️ Benefits

• Equal Employment Opportunity commitment and nondiscrimination protections • No visa sponsorship available at this time