Responsibilities
- Lead CMS (Centers for Medicare & Medicaid Services) bid development and HPMS (Health Plan Management System) 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
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 (HPMS, MARx, RAPS/EDPS)
Nice to Have
- FSA and/or MAAA designation
- Experience with ISNP, D-SNP, or dual-eligible populations
- Part D pricing and/or reconciliation experience
- Exposure to RADV audits and encounter data processes
