SCOPE OF ROLE

The Actuarial Consultant will have a lead role in Risk Adjustment modeling, reporting, and forecasting for the Medicare Advantage line of business. 

ROLE RESPONSIBILITIES

The Actuarial Consultant job description is intended to point out major responsibilities within the role, but it is not limited to these items:

• Work in tandem with the Risk Adjustment Director to support model development and reporting
• Develop monthly accruals for all Medicare Risk Adjusted payments
• Support the development of forecasting models, projections, and relevant information to inform C-Level business decisions
• Routinely partner on shared objectives with Risk Adjustment Analytics and Operations teams
• Develop ROI calculations for Risk Adjustment vendor contracts
• Provide analyses related to various audits including internal, RADV, OIG, and external review
• Support the team through modeling, market analysis, and experience to determine company growth initiatives; conduct research and data analysis
• Perform ad-hoc data analysis
• Support MA Bid development including Risk Adjustment trend
• Support product and line of business strategy by working with LOB leadership
• Individual contributor and SME for MA Risk Adjustment, supporting strategy and plan design discussions, market positioning, and regulatory landscape

SUPERVISORY RESPONSIBILITIES

• This position will have supervisory responsibilities as the team grows

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

• A Bachelor’s degree required in Math, Statistics, Economics, Actuarial Science, or a related field is required
• Four (4) or more years of experience working with Medicare Advantage and/or Part D products is preferred
• Associate in the Society of Actuaries or higher is preferred

PROFESSIONAL COMPETENCIES

• Proficient in at least one high-level programming language such as Python, SAS, R, Spark, Scala
• Expert-level knowledge of Microsoft Excel and other Office products
• Experience with modeling and forecasting Risk Adjustment accruals
• Intermediate to expert-level knowledge of Medicare Advantage Risk Adjustment
• Produce, understand, and interpret internal and external analysis and reports; provide effective technical and non-technical support to internal and external stakeholders
• Strong communication skills and ability to meet with C-Level leadership on pricing and plan-related topics
• Experience working with big data is a big plus

LICENSURES AND CERTIFICATIONS

• Associateship or greater in the Society of Actuaries or commensurate years of experience

WORK ENVIRONMENT

• The majority of work responsibilities are performed in an open office setting, carrying out detailed work sitting at a desk/table and working on the computer. Some travel may be required.