Senior Consulting Actuary

ActuaryActuaryFull TimeRemoteTeam 501-1,000Since 1974H1B No SponsorCompany SiteLinkedIn

Location

United States

Posted

39 days ago

Salary

$200K - $275K / year

Professional Certificate15 yrs expEnglish

Job Description

• Lead actuarial engagements for state Medicaid agencies and other public health clients. • Design and oversee encounter data analytics, validating completeness and accuracy, producing utilization trend analyses, and reconciling encounter to financial data for managed care oversight. • Develop and certify Medicaid managed care capitation rates that are actuarially sound, including risk adjustment methodologies. • Develop and apply risk scoring methodologies to support capitation rate rebalancing, including calculation of individual risk scores and risk-adjusted settlements. • Conduct financial analyses and modeling for HCBS, LTSS, and PACE programs. • Provide strategic guidance on program design, waiver development and submission support, and value-based payment models. • Support federal authority activities, including cost-effectiveness and budget-neutrality analyses for 1915(b)/(c) and 1115 waivers, state plan amendments, directed payments, and provider tax programs. • Conduct ad hoc fiscal and policy impact analyses, including rate modifications, hospital rebasing, UPL/GME payments, and pay-for-performance calculations. • Collaborate with multidisciplinary teams including underwriters, policy experts, data analysts, health economists, and clinical consultants. • Present complex actuarial findings to clients, stakeholders, and regulatory bodies in a clear and actionable manner. • Mentor junior actuarial staff and contribute to professional development initiatives. • Stay current with federal and state regulations, CMS guidance, and emerging trends in commercial and public health programs.

Job Requirements

  • FSA or ASA with active membership in the AAA (required).
  • 15+ years of health actuarial experience, including at least 5 years supporting or employed by a state Medicaid agency.
  • Demonstrated ability to lead a team of actuaries.
  • Proven experience developing actuarially sound managed care capitation rates, risk adjustment methodologies, and waiver cost-effectiveness models.
  • Deep familiarity with CMS review processes, federal regulatory standards, and ASOP compliance.
  • Expertise with Medicaid and commercial claims/encounter data, including All-Payer Claims Databases (APCDs) and Medicaid Management Information Systems (MMIS).
  • Excellent communication skills and a strong record of producing defensible actuarial documentation for CMS, state agencies, and legislative oversight entities.
  • An executive presence and strong client relation skills.
  • Experience providing expert testimony or support in rate hearings and rate negotiations preferred.
  • Ability to work in a collaborative environment.
  • A desire to generate new business strongly preferred.
  • Advanced skills in Microsoft Excel, Word, PowerPoint.

Benefits

  • Eligible employees have access to benefits that go beyond what’s expected to support their physical, mental, career, social, and financial well-being. Visit our website for a complete list of benefits and a look into our culture: Experience BerryDunn.

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