Actuary (CMS Regulatory & Bid Pricing)
$135,000–$160,000 year
RemoteUnited States
United StatesRemoteFull Time$135,000–$160,000 yearLarge
Full TimeLarge
Job Summary
Lead CMS bid development and HPMS filings for Medicare Advantage plan years while building and maintaining IBNR reserve modeling to support monthly close cycles. Perform risk adjustment modeling, HCC analysis, and CMS payment reconciliation, then monitor data systems including HPMS, MARx, and RAPS/EDPS. Translate actuarial findings into actionable insights for finance, clinical, compliance, and executive leadership teams. Manage multiple deliverables across competing deadlines during bid season and filing cycles. Partner cross-functionally to solve complex healthcare challenges and strengthen reporting processes.
Required Qualifications
- Bachelor's degree in Actuarial Science, Mathematics, Statistics, or related quantitative field
- ASA (Associate of the Society of Actuaries)
- 5- 8+ years of actuarial experience, with a strong preference for healthcare or managed care settings
- Minimum 2 years of Medicare Advantage health plan experience
- Hands-on experience with CMS bid development and HPMS submissions
- Experience with risk adjustment modeling, HCC analysis, and CMS payment reconciliation
- Advanced proficiency in Excel and actuarial modeling tools
- Experience using SAS, R, Python, or SQL to analyze large healthcare datasets
- Experience working with CMS data systems (HPMS, MARx, RAPS/EDPS)
Desired Qualifications
- FSA and/or MAAA designation
- Experience with ISNP, D-SNP, or dual-eligible populations
- Part D pricing and/or reconciliation experience
- Exposure to RADV audits and encounter data processes
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