Associate Actuary, CMS Regulatory & Bid Pricing

🕒 April 24

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Curana Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🤝 B2B

⚕️ Healthcare Insurance

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 filing for Medicare Advantage plan years • Build and maintain IBNR reserve models; support monthly close and financial reporting • 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 Part D pricing models and support Part D reconciliation processes • Translate actuarial findings into clear, actionable insights for non-actuarial audiences • Partner cross-functionally with finance, clinical, compliance, and network teams • Manage multiple deliverables across competing deadlines including bid season and CMS filing cycles

🎯 Requirements

• Associate of the Society of Actuaries (ASA) required; Fellow (FSA) strongly preferred • Member of the American Academy of Actuaries (MAAA) preferred • Bachelor's degree in Actuarial Science, Mathematics, Statistics, or a related quantitative field • 5 to 8+ years of actuarial experience, with a strong preference for healthcare or managed care settings • Minimum 2 years of direct experience working with a Medicare Advantage health plan (required) • Prior experience with ISNP, D-SNP, or dual-eligible populations strongly preferred • Hands-on CMS bid development and HPMS filing experience • Risk adjustment modeling, HCC analysis, and CMS payment reconciliation experience • Part D pricing and/or reconciliation experience a plus • Exposure to RADV audit methodology and encounter data quality a plus • Advanced proficiency in Excel and actuarial modeling tools • Experience with SAS, R, Python, or SQL for data extraction and analysis • Familiarity with CMS data systems including HPMS, MARx, and RAPS/EDPS • Ability to work with large claims datasets and synthesize findings clearly

🏖️ Benefits

• Health insurance • 401(k) matching • Flexible work hours