Our client, a leading health insurer, is seeking a Senior Actuarial Analyst to join their team and help assess and manage actuarial risks for Medicare Advantage plans. The ideal candidate will have strong actuarial and data analysis skills, as well as experience in the Medicare space, to support pricing, forecasting, and risk management efforts.
Key Responsibilities:
- Support the development and execution of Medicare Advantage bids, including actuarial modeling, pricing, and forecasting based on healthcare utilization and claims history.
- Analyze medical claims data and member risk profiles to assess and manage the financial performance of Medicare Advantage products.
- Collaborate with cross-functional teams (e.g., operations, finance, and underwriting) to develop competitive pricing and strategic bid packages that align with business goals and regulatory requirements.
- Evaluate risk exposure and identify trends within the Medicare population to inform decision-making and future business strategy.
- Track and report on financial performance, providing insights on variances from forecast and suggesting improvements to optimize cost management and profitability.
- Assist in the preparation and review of Medicare Advantage submissions to ensure compliance with federal and state regulations, including adjustments for risk adjustment (RA) factors.
Qualifications:
- 4-5 years of actuarial experience, preferably in the Medicare Advantage or health insurance industry, with a focus on pricing, forecasting, or risk management.
- Experience with actuarial software (e.g., SAS, SQL, or BBA) and data analytics tools to analyze large, complex datasets.
- Minimum of 3 actuarial exams completed and on track to achieving ASA
- Medicare Bid experience is preferred but not required
- Excellent analytical, communication, and problem-solving skills, with the ability to translate complex actuarial concepts into actionable business recommendations.
