Lead Actuarial Consultant – Medicare MSSP, Medicare Advantage Bid
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Job Description
Lead Actuarial Consultant specializing in actuarial analyses and financial modeling for Medicare MSSP and Advantage clients. Collaborating across teams to deliver analytical solutions.
Responsibilities:
- Design and execute actuarial financial analyses for MSSP Accountable Care Organization (ACO) clients, including benchmark development, savings calculations, and risk score trends.
- Lead rate development and rate review engagements for Medicare and other healthcare program clients, ensuring actuarial soundness and regulatory compliance.
- Build and maintain robust actuarial models for medical cost projections, utilization trend analysis, and PMPM rate development.
- Access, query, and analyze CMS Medicare claims data through the Chronic Conditions Warehouse Virtual Research Data Center (CCW VRDC) to support client analytics and population health studies.
- Collaborate with data engineers and data scientists to leverage Innovaccer's health data platform for enhanced analytics capabilities.
- Serve as actuarial lead on client engagements, presenting findings and recommendations to health plan and provider organization leadership.
- Ensure all work products comply with applicable CMS regulations, Actuarial Standards of Practice (ASOPs), and the Actuarial Code of Professional Conduct.
- Mentor senior actuarial analysts and review their work products for technical accuracy and compliance.
- Contribute to the development of new actuarial service offerings and internal intellectual property.
- Support business development activities including proposal writing, client presentations, and thought leadership content.
Requirements:
- ASA designation preferred
- Minimum 6+ years of actuarial experience in healthcare, with significant Medicare-focused work.
- Strong working knowledge of MSSP program mechanics, benchmark methodology, risk score adjustment, and ACO financial reconciliation.
- Experience with rate development and/or rate review processes for Medicare or other government healthcare programs.
- Proficiency in actuarial modeling tools and data analysis platforms (SAS, SQL, R, Python, or equivalent).
- Strong written and verbal communication skills with demonstrated ability to present complex analyses to non-technical stakeholders.
- Experience working in a consulting, health plan, or managed care actuarial environment.
Benefits:
- Generous Paid Time Off: Recharge and relax with 22 days of fixed time off per year, in addition to company holidays—because we believe work-life balance fuels performance.
- Best-in-Class Parental Leave: Spend quality time with your growing family. We offer one of the industry’s most generous parental leave policies to support you during life’s most important moments.
- Recognition & Rewards: We celebrate wins—big and small. Get rewarded with monetary incentives and company-wide recognition for your impact and dedication. Your hard work won’t go unnoticed.
- Comprehensive Insurance Coverage: Stay covered with medical, dental, and vision insurance, plus 100% company-paid short- and long-term disability and basic life insurance. Optional perks include discounted legal aid and pet insurance.
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