Actuary – CMS Regulatory, Bid Pricing

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee the development of CMS bids and HPMS filings for Medicare Advantage plan years.

• Create and sustain IBNR reserve modeling while assisting with monthly closing and financial reporting cycles.

• Conduct risk adjustment modeling, HCC analysis, and CMS payment reconciliations.

• Track and respond to CMS data systems, including HPMS, MARx, and RAPS/EDPS.

• Aid in the preparation for RADV audits and review encounter data quality.

• Design and maintain Part D pricing models, supporting the reconciliation processes.

• Convert actuarial findings into clear, actionable insights for stakeholders without actuarial backgrounds.

• Collaborate across finance, clinical, compliance, and network teams.

• Handle multiple deliverables amidst competing deadlines, particularly during bid season and CMS filing cycles.

• Support or spearhead the CMS bid submission process.

• Provide precise, actionable insights derived from risk and financial modeling.

• Enhance reserve modeling and reporting processes.

• Offer clear recommendations ready for executive presentations.

⛳️ Requirements

• A bachelor's degree in Actuarial Science, Mathematics, Statistics, or a related quantitative discipline.

• ASA (Associate of the Society of Actuaries) certification is required.

• 5–8+ years of experience in actuarial roles.

• At least 2 years of experience specifically in Medicare Advantage health plans is necessary.

• Strong preference for candidates with healthcare or managed care experience.

• Practical experience in CMS bid development and HPMS submissions.

• Familiarity with risk adjustment modeling, HCC analysis, and CMS payment reconciliation.

• Advanced skills in Excel and actuarial modeling software.

• Proficiency in using SAS, R, Python, or SQL for analyzing large healthcare datasets.

• Experience with CMS data systems such as HPMS, MARx, and RAPS/EDPS.

• FSA and/or MAAA designation is preferred.

• Experience with ISNP, D-SNP, or dual-eligible populations is preferred.

• Preference for candidates with experience in Part D pricing and/or reconciliation.

• Exposure to RADV audits and encounter data processes is preferred.

• Must be able to work in the United States; visa sponsorship is not available.

🏝️ Benefits

• Commitment to Equal Employment Opportunity and a non-discrimination policy.

• No visa sponsorship available (H1B or otherwise).