Actuarial Director
We are seeking a strategic and analytical Director of Actuarial Services with deep expertise in value-based care, particularly within ACO REACH and Medicare Shared Savings Program (MSSP) models. The ideal candidate will hold an ASA or FSA designation and have a strong background in healthcare analytics, risk adjustment, benchmark setting, and financial performance evaluation.
Key Responsibilities:
Lead actuarial strategy and support for ACO REACH and MSSP initiatives, including performance forecasting, trend analysis, and risk adjustment modeling.
Partner with finance, population health, and clinical operations to evaluate program performance and inform strategic decisions.
Provide actuarial insights into benchmark development, shared savings/loss calculations, and attribution models.
Ensure compliance with CMS guidelines and interpret regulatory impacts on actuarial models.
Develop and mentor actuarial staff; foster a culture of analytical excellence and innovation.
Qualifications:
ASA or FSA designation required.
7+ years of actuarial experience in healthcare; strong focus on Medicare Advantage, ACO, or value-based care models.
In-depth understanding of ACO REACH, MSSP, and related CMS programs.
Proficient in data modeling, predictive analytics, and risk adjustment methodologies (e.g., HCC coding).
Strong communication skills with the ability to present complex actuarial findings to non-technical stakeholders.
Experience with tools such as SAS, SQL, Python, or R preferred.
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