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Actuarial Director
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Selby Jennings
Chicago, IL (In Person)
Full-Time
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Job Description
Seeking a highly skilled Actuary with a focus is Medicare Advantage Risk Adjustment.
This role is ideal for a strategic thinker who is deeply technical, detail‑oriented, and thrives in a fast‑paced, data‑rich environment. Key Responsibilities Medicare Advantage Financial Reporting & Revenue Modeling Lead actuarial financial reporting for Medicare Advantage and full‑risk provider groups. Analyze Monthly Membership Report (MMR) data to evaluate revenue trends and expected payments. Develop models to project accrual-based revenue , including considerations for: Mid-year and final risk score trends Membership shifts CMS payment changes Produce executive-level insights on revenue performance, drivers, and variances. Partner with finance and operations to support budget planning and forecasting cycles. RAF Forecasting & Actuarial Modeling Build and maintain actuarial models to forecast Risk Adjustment Factor (RAF) at member, cohort, and population levels. Provide scenario modeling and sensitivity analyses to predict RAF outcomes under multiple operational strategies. Support coding, clinical, and operations teams by quantifying the financial impact of interventions. CMS File Processing & Analytic Readiness Lead ingestion and transformation of CMS and payer data files for reporting and analytics use. Write optimized SQL code to create analytic-ready tables, ensuring accuracy, traceability, and compliance with CMS formats. Collaborate with data engineering teams to validate data quality and maintain controlled production workflows. Required Qualifications ASA or FSA credential (or equivalent actuarial experience). 7+ years of actuarial experience with a focus on Medicare Advantage risk adjustment . Deep expertise with CMS risk adjustment models, payment methodology, and file structures. Advanced SQL skills -capable of writing complex queries, building pipelines, and transforming large datasets. Strong understanding of actuarial forecasting methods and predictive modeling. Proven ability to translate complex analysis into executive-ready insights. Experience collaborating cross-functionally with operations, clinical, data engineering, and finance. Key Competencies Strategic decision-making and analytical rigor Technical depth in actuarial modeling and SQL Strong communication and stakeholder alignment Ability to operate both at a high-level and in detailed technical work Continuous improvement mindset and passion for innovation
This role is ideal for a strategic thinker who is deeply technical, detail‑oriented, and thrives in a fast‑paced, data‑rich environment. Key Responsibilities Medicare Advantage Financial Reporting & Revenue Modeling Lead actuarial financial reporting for Medicare Advantage and full‑risk provider groups. Analyze Monthly Membership Report (MMR) data to evaluate revenue trends and expected payments. Develop models to project accrual-based revenue , including considerations for: Mid-year and final risk score trends Membership shifts CMS payment changes Produce executive-level insights on revenue performance, drivers, and variances. Partner with finance and operations to support budget planning and forecasting cycles. RAF Forecasting & Actuarial Modeling Build and maintain actuarial models to forecast Risk Adjustment Factor (RAF) at member, cohort, and population levels. Provide scenario modeling and sensitivity analyses to predict RAF outcomes under multiple operational strategies. Support coding, clinical, and operations teams by quantifying the financial impact of interventions. CMS File Processing & Analytic Readiness Lead ingestion and transformation of CMS and payer data files for reporting and analytics use. Write optimized SQL code to create analytic-ready tables, ensuring accuracy, traceability, and compliance with CMS formats. Collaborate with data engineering teams to validate data quality and maintain controlled production workflows. Required Qualifications ASA or FSA credential (or equivalent actuarial experience). 7+ years of actuarial experience with a focus on Medicare Advantage risk adjustment . Deep expertise with CMS risk adjustment models, payment methodology, and file structures. Advanced SQL skills -capable of writing complex queries, building pipelines, and transforming large datasets. Strong understanding of actuarial forecasting methods and predictive modeling. Proven ability to translate complex analysis into executive-ready insights. Experience collaborating cross-functionally with operations, clinical, data engineering, and finance. Key Competencies Strategic decision-making and analytical rigor Technical depth in actuarial modeling and SQL Strong communication and stakeholder alignment Ability to operate both at a high-level and in detailed technical work Continuous improvement mindset and passion for innovation