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Senior Actuarial Analyst

Job Summary:

The Senior Actuarial Analyst will play a pivotal role in ArchWell Health’s growth and within the Actuarial Department.  This Analyst’s contribution will be key to the organization’s collective success. This role will work closely and collaboratively with various departments, providing insights that support strategic business decisions and optimize financial performance.

Department Duties/Responsibilities:

• Risk Adjustment and Revenue Performance:
  • Develop and maintain models to forecast risk-adjusted revenue across Medicare Advantage contracts
  • Analyze historical risk score trends, RAF accuracy, and coding opportunities to identify gaps and performance drivers
  • Support the annual budget process, quarterly projections, monthly accruals, and variance explanations
  • Evaluate the impact of HCC model updates and CMS rule changes on organizational revenue
  • Perform Ad-hoc Revenue Analysis to evaluate financial impacts of operational initiatives, clinical programs, membership shifts, and emergent business questions

• Reserving and Monthly Close processes:
  • Assist in monthly IBNR development and selection process.
  • Prepare necessary monthly reporting as a key contributor within the monthly closing cycle.

• Forecast and Modeling:
  • Develop and maintain models to forecast future medical cost and revenue and/or evaluate the financial impact of various interventions.
  • Partner with department heads to understand key business drivers and assumptions, ensuring alignment with strategic objectives.
  • Prepare comprehensive financial reports and variance analyses for senior management and key stakeholders.
  • Conduct ad hoc financial analyses to support special projects, strategic initiatives, and investment opportunities.

• Data Analysis:
  • Analyze payor healthcare data (claims, utilization, costs) to identify trends, cost drivers, and opportunities for improvement. 
  • End to end payor reconciliations (detail vs summary, external vs internal data feeds, and additional reconciliation as needed).
  • Payor outreach and internal point of contact related to file requests, data gaps, and other supplemental reporting and information available

• Business Performance Monitoring:
  • Monitor and analyze key performance indicators (KPIs) and operational metrics to assess business performance and identify areas of improvement.
  • Collaborate with operational teams to develop actionable insights and recommendations for performance enhancement and risk mitigation.
  • Evaluate the cost-effectiveness and value of different healthcare interventions, programs, and policies. 
  • Assist in the development of executive-level dashboards and reporting tools to track financial and operational performance against targets.

• Cross-Functional Collaboration:
  • Collaborate cross-functionally with IT, finance, accounting, operations, and other departments to streamline processes, improve data accuracy, and enhance financial reporting capabilities.

Required Skills/Abilities:

• Prior experience within Medicare Advantage
• Understanding of CMS-HCC models (v24/v28), CMS risk adjustment methodology, and RAF score calculation
• Proficiency in modeling, forecasting, and/or variance analysis
• Advanced proficiency in Microsoft Excel
• Prior usage and strong understanding of SQL (2+ years preferred)
• Understanding of profit and loss statements and ability to work with larger datasets behind them
• Analytical, problem-solving, and critical thinking skills
• Ability to work effectively in a fast-paced, dynamic environment and managing multiple priorities simultaneously
• Strong interpersonal skills with the ability to collaborate cross-functionally and build positive working relationships at all levels of the organization.
• Occasional travel required, no more than 10%-15%

Minimum Qualifications:

• Bachelor's degree in Actuarial Science, Mathematics, Statistics, Finance, Economics, or related field required; MBA or advanced degree preferred.
• At least of 3-6 years relevant Actuarial experience within healthcare preferred.
• 2+ Actuarial Exams, Pre-ASA or ASA level

• Embodies and serves as a role model of ArchWell Health’s Values:
  • Be compassionate
  • Strive for excellence
  • Earn trust
  • Show respect
  • Stay resilient
  • Always do the right thing

About ArchWell Health:

At ArchWell Health, we’re creating a community of caring designed to help our members stay healthy and engaged. By focusing on a strong provider-patient relationship, routine wellness, and staying active, our members enjoy a higher level of care and better quality of life after the age of 60. Everything we do is for seniors. We believe seniors should be heard, listened to, and given ample time by their physicians to live well later in life.

Our value-based care model is designed to prevent illnesses while keeping members healthy and happy in every aspect of their life. We deliver best-in-class primary care at comfortable, accessible neighborhood centers where older adults can feel at home and become part of a vibrant, wellness-focused community. We’re passionate about caring for older adults and united by the belief that caring has the power to change everything for our members.

ArchWell Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected classification.