Actuarial Analyst V Risk Adjustment

This role will focus on advancing actuarial insights that improve risk adjustment performance across Medicare Advantage and ACA populations. Key areas of emphasis include HCC model analytics, forecasting of RAF scores, and the development of predictive models using clinical and claims data. The analyst will play a key role in shaping data-driven strategies to support accurate documentation, optimize financial outcomes, and inform enterprise decision-making. This is a highly collaborative and technical role that blends deep actuarial thinking with practical applications in government programs population health and revenue optimization.

• Practices self-leadership and promotes learning in others by building relationships with cross-functional stakeholders; communicating information and providing advice to drive projects forward; influencing team members within assigned unit; listening and responding to, seeking, and addressing performance feedback; adapting to competing demands and new responsibilities; providing feedback to others, including upward feedback to leadership and mentoring junior team members; creating and executing plans to capitalize on strengths and develop weaknesses; and adapting to and learning from change, difficulties, and feedback.


• Conducts or oversees business-specific projects by applying deep expertise in subject area; promoting adherence to all procedures and policies; developing work plans to meet business priorities and deadlines; determining and carrying out processes and methodologies; coordinating and delegating resources to accomplish organizational goals; partnering internally and externally to make effective business decisions; solving complex problems; escalating issues or risks as appropriate; monitoring progress and results; recognizing and capitalizing on improvement opportunities; and evaluating recommendations made by others.


• Completes actuarial documentation by reviewing and coordinating the actuarial portion of financial reports and tax returns, and responses to insurance regulations; and presenting results internally to mid-level leadership.


• Develops and designs product line evaluations by interpreting and communicating findings of analysis of product line financials, reserve, valuation , cash flow analysis; and interpreting product line performance, risk, and assumptions used in product development.


• Designs and develops actuarial research by designing complex methods to advance standards, assumptions, and the legal and regulatory environment.


• Assesses, analyzes and interprets financial risks and opportunities by using non-traditional actuarial methods and actuarial judgment when conducting actuarial analyses.


• Leads collaboration with business partners by translating complex actuarial constructs into actionable recommendations; and developing and formulating accurate actuarial and financial advice in compliance with the Actuarial Standards of Practice.


• Creates framework and assumptions for new, existing, and non-traditional actuarial models to meet business needs.