Senior Consulting Actuary

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

📋 Description

• Lead actuarial projects for state Medicaid agencies and various public health clients.

• Design and manage encounter data analytics, ensuring their completeness and accuracy.

• Generate utilization trend analyses and reconcile encounter data with financial data for managed care oversight.

• Develop and certify actuarially sound capitation rates for Medicaid managed care, including methodologies for risk adjustment.

• Create and implement risk scoring methodologies for capitation rate rebalancing, individual risk scores, and risk-adjusted settlements.

• Perform financial analyses and modeling for HCBS, LTSS, and PACE programs.

• Provide strategic insights on program design, waiver development, submission support, and value-based payment models.

• Assist with federal authority activities, including analyses for cost-effectiveness and budget neutrality for waivers, state plan amendments, directed payments, and provider tax programs.

• Carry out fiscal and policy impact analyses, including rate modifications, hospital rebasing, UPL/GME payments, and calculations for pay-for-performance.

• Collaborate with underwriters, policy experts, data analysts, health economists, and clinical consultants.

• Present intricate actuarial findings to clients, stakeholders, and regulatory authorities.

• Mentor junior actuarial personnel and engage in professional development initiatives.

• Remain updated on federal and state regulations, CMS guidance, and emerging trends in commercial and public health.

⛳️ Requirements

• FSA or ASA with active membership in the American Academy of Actuaries (mandatory).

• Over 15 years of experience in health actuarial roles.

• Minimum of 5 years of experience supporting or working within a state Medicaid agency.

• Proven capability to lead a team of actuaries.

• Experience in developing actuarially sound managed care capitation rates.

• Familiarity with risk adjustment methodologies and cost-effectiveness models for waivers.

• In-depth knowledge of CMS review processes, federal regulatory standards, and compliance with ASOP.

• Proficiency with Medicaid and commercial claims/encounter data, including APCDs and MMIS.

• Exceptional communication skills and a strong history of producing defensible actuarial documentation.

• Strong executive presence and client relationship skills.

• Ability to thrive in a collaborative work environment.

• Advanced proficiency in Microsoft Excel, Word, and PowerPoint.

• Preferred experience in providing expert testimony or support during rate hearings and negotiations.

• Strong desire to generate new business is highly preferred.

🏝️ Benefits

• Comprehensive benefits that promote physical, mental, career, social, and financial well-being.

• Opportunities for growth and advancement.

• Initiatives for professional development.

• Minimal travel requirements, less than 20% annually.

• Reasonable accommodations available for the job application, interview process, or essential job functions.