Actuarial Manager, Medicare Value-Based Care

Overview

The organization is seeking a senior individual contributor for the role of Actuarial Manager, Medicare Value-Based Care. This fully remote position will support monthly results processing for Medicare value-based programs, payer settlement reconciliation, and month-end close deliverables. The Manager will also lead high-priority analyses and coach analysts as a player-coach.

This role requires work authorization to work in the United States without employer sponsorship, now or in the future.

Responsibilities

Value-Based Program Results (ACO REACH/LEAD and MSSP)

• Own the end-to-end monthly results process, including:
  • Coordinate membership and revenue data intake from partner teams
  • Run the retrospective trend adjustment (RTA) model
  • Oversee claims reserving and projection processes
• Guide the transition from ACO REACH to ACO LEAD by partnering with the Central actuarial team on new requirements (tools/methodology) and supporting strategy with the VP of Direct Contracting
• Consolidate results into clear summaries and lead the monthly results presentation to Regional CFOs on the Market Finance team

Payer Settlement Reconciliation

• Review payer contract terms to determine how final settlements should be calculated
• Reconcile settlement calculations against contract terms and underlying claims and revenue data
• Identify discrepancies and develop the analytical case to challenge settlements not handled correctly, supporting the team’s annual savings targets
• Represent the finance organization with payer counterparts in a polished, professional manner, including raising questions and requesting needed details for review

Medicare Advantage Month-End Close Support

• Build and maintain supplemental close exhibits, including schedules of revenue accrual assumptions and accrual amounts by payor and market
• Transform actuarial team outputs into required inputs for FP&A
• Quantify and present drivers of claims prior period development, separating natural month-over-month runout from methodology updates and other one-time considerations

Special Projects and Analyst Coaching

• Lead project intake, prioritization, and progress tracking across the actuarial team
• Lead end-to-end, high-priority ad hoc analyses across markets and topics based on team needs
• Coach and mentor analysts through project work by providing technical direction and review to expand team capacity and improve work product quality
• Represent actuarial leadership in cross-functional forums and working groups; bring decisions back to the actuarial team and ensure completion of takeaway deliverables

Process Innovation

• Serve as a thought leader on AI adoption within the actuarial organization, sharing what works and building team fluency and confidence in applying new tools
• Apply AI tools to claims analysis, automation of financial reporting, enablement of strategic decision-making, and review of payor contracts and financial statements
• Support build-out of improved actuarial team processes

Other Responsibilities

• Develop talent through coaching, mentorship, and technical review
• Collaborate with Market Finance, FP&A, Accounting, Medical Economics, Payer Contracting, and Regional Presidents
• Identify critical issues and recommend solutions to business problems
• Contribute to and exemplify core organizational values

Time Allocation (Approximate)

• ~40% CMS value-based program results
• ~40% ad hoc projects and analyst coaching
• ~20% annual payer financial settlement work and select MA close deliverables

Qualifications

Required

• 6+ years of actuarial experience (8+ years preferred)
• Demonstrated leadership through project ownership and cross-functional initiatives, mentoring analysts, serving as a trusted delegate for a senior leader, and/or prior people management
• ASA or FSA designation
• Bachelor’s degree

Knowledge, Skills, and Abilities

• Strong ability to communicate and present a financial narrative (written and verbal)
• Strong understanding of Medicare Advantage and value-based care concepts; experience with other CMS value-based arrangements (ACO REACH or MSSP) is a plus
• Understanding of MA health plan data (Claims, MMR, MAO-004, etc.)
• Ability to read and interpret payer contracts and translate terms into settlement expectations
• Experience with reserving and/or forecasting; ability to lead work in these competencies
• Skilled in interpreting and manipulating large datasets, especially medical claims
• Proficiency with Excel and SQL; experience applying AI tools to actuarial work is a plus
• Comfortable operating as a player-coach (hands-on analysis while guiding others)
• Advanced problem-solving skills (identify issues, determine causes, develop solutions, and plan implementation)
• Proven ability to influence, grow, and motivate others

Preferred Qualifications

• Experience with other CMS value-based arrangements (ACO REACH or MSSP)
• Experience applying AI tools to actuarial work

Compensation & Benefits

• Pay range: $129,700.00 - $162,100.00
• Salary range is a guideline; individual compensation packages may vary based on factors including skill set, experience, and qualifications.

Location

• Remote - MD