Senior Consulting Actuary - Risk Adjustment

Overview

This role involves serving as a Senior Consultant with specialized experience in Affordable Care Act (ACA) risk adjustment analytics. The position leads client engagements, coordinates multidisciplinary teams, develops actionable recommendations, and supports the ongoing growth of risk adjustment offerings.

Key focus areas include knowledge of ACA risk adjustment (including setting risk accruals), experience working with EDGE data and risk adjustment operational teams, project leadership, and the ability to clearly communicate complex concepts to senior leaders.

Responsibilities

• Client leadership and communication

  • Serve as a primary point of contact for clients and partner with actuarial, coding, data, and operational experts to deliver integrated solutions.
  • Communicate findings effectively to client stakeholders.

• Project and team leadership

  • Develop and manage project plans, timelines, workflows, and deliverables across multiple engagements.
  • Mentor junior staff and maintain high-quality work.

• Risk adjustment analytics

  • Lead ACA risk adjustment analyses, including accrual development and EDGE data evaluation.
  • Provide strategic support to health plan executives.
  • Assess financial and operational impacts.

• Client deliverables and presentations

  • Draft clear, actionable deliverables.
  • Present results, recommendations, and risk adjustment concepts to client leadership.

• Product and methodology proficiency

  • Apply relevant tools, products, methodologies, and risk adjustment expertise to address client needs and support internal initiatives.

• Business development support

  • Contribute to requests for proposals, proposal development, strategic scoping discussions, service innovation, and growth of risk adjustment offerings.

• Market and regulatory insight

  • Monitor ACA risk adjustment developments.
  • Translate market and regulatory changes into practical client strategies.

• Cross-functional collaboration

  • Coordinate with actuarial, coding, operations, data analytics, and other multidisciplinary teams to deliver comprehensive solutions.

Qualifications

• Demonstrated experience leading ACA risk adjustment analytics within a health plan or leading strategic risk adjustment consulting engagements.
• Deep understanding of the ACA risk adjustment program and its impact on health plan rate filings and financial performance.
• Strong knowledge of the full risk adjustment lifecycle, including coding, submissions, analytics, provider engagement, and regulatory requirements.
• Proven ability to manage projects, workflows, timelines, and deliverables across multiple engagements.
• Strategic perspective with the ability to anticipate market or regulatory changes and translate them into actionable client recommendations.
• Ability to build trusted client relationships and communicate complex technical, analytical, and operational concepts clearly to senior leadership.
• Demonstrated leadership, initiative, accountability, and sound judgment in client and team interactions.
• Commitment to mentoring team members and contributing to a collaborative learning environment.
• Excellent written and verbal communication skills, with proven success working across cross-functional and multidisciplinary teams.

Education and Experience

• Education/Training: Minimum of a bachelor’s degree in actuarial science, mathematics, economics, or statistics required.
• Designation: FSA designation or ASA designation with additional experience also required.
• Experience: Minimum of 8 years of healthcare actuarial experience in one or more of the following areas: Medicaid, healthcare reform, ACA, Provider Sponsored Organizations, and Medicare Advantage.
• At least 2 years of project management or client management experience required.

Additional Responsibilities (Supervisory)

• Manage actuarial project teams to ensure quality and timely deliverables.
• Provide supervisory responsibilities.

Work Performed and Job Requirements

• Client management

  • Develop and maintain client relationships.
  • Implement initiatives for products, tools, and services through training and regular meetings.
  • Manage and understand individual client needs and develop strategic plans to meet those needs.
  • Manage client relationships including client visits, ongoing correspondence, and feedback.
  • Mitigate risk by ensuring client contracts, documentation, and processes are followed.

• Project management

  • Supervise and account for execution of project plans.
  • Conduct periodic reviews of project plans, final deliverables, and post-project results.
  • Oversee project communication and provide venues for constructive feedback.
  • Ensure project teams provide quality deliverables, updates, and billing clients within timelines.
  • Delegate work appropriately.

• Professional/industry development

  • Maintain credentials, signing authority, and health care knowledge through continuing education.
  • Implement industry training for internal/external initiatives.
  • Identify needs and align employee career path plans.
  • Manage creation of additional resources and reference materials.

• New business development

  • Implement activities to support growth, including participating in seminars/events and research papers.
  • Generate new business and/or product lines by executing on established action plans.
  • Manage new marketing initiatives to generate sales leads.
  • Introduce new value-add services to current clients.

• Internal operations

  • Prioritize and manage operational efficiency initiatives.
  • Administer compliance of policies and procedures to ensure cross-office collaboration.
  • Recruit top talent and participate in selection and orientation.
  • Oversee and participate in community and professional volunteer activities/opportunities.

• Other duties

  • All other duties as assigned.

Knowledge, Skills, and Abilities

• Initiative: Ability to decide independently what actions should be taken.
• Effective communication: Ability to convey thoughts and ideas effectively, verbally and in writing.
• Team player: Builds constructive working relationships with acceptance, cooperation, and mutual respect.
• Time management: Estimates resources needed and uses methods to plan and track work and commitments.
• Continuous learning: Commitment to increasing skills.
• Leadership: Develops ability in others through ongoing feedback and learning opportunities.
• Emotional intelligence: Exercises sound judgment consistently.
• Strategic thinking: Formulates objectives and priorities and implements plans aligned with long-term interests.

Compensation & Benefits

• Not specified in the provided job description.

Location

• Not specified in the provided job description.

Equal Opportunity

Equal Opportunity Employer / Protected Veterans / Individuals with Disabilities.

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. Employees who have access to compensation information as part of essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action (including an investigation conducted by the employer), or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)