Manager, Actuarial Services 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.

• Pursues professional growth and provides developmental opportunities for others by soliciting and acting on performance feedback; building collaborative, cross-functional relationships; training and developing talent for growth opportunities; delegating tasks and decisions; fostering open dialogue amongst team members; executing performance management guidelines and expectations; and working closely with employees to set goals and provide open feedback and coaching to drive performance improvement.


• Manages designated work unit by translating business plans into tactical action items; ensuring all policies and procedures are followed; delegating tasks to meet goals and objectives; overseeing the completion of work assignments; aligning team efforts; building accountability for and measuring progress in achieving results; identifying and addressing improvement opportunities; removing obstacles that impact performance; and guiding performance and developing contingency plans accordingly.


• Completes actuarial documentation by reviewing and coordinating the actuarial portion of financial reports and tax returns, and responses to insurance regulations; recommending report needs; 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, pricing, reserve, valuation , cash flow analysis; interpreting product line performance, risk, and assumptions used in product development; and coaches and develops staff while ensuring business needs or requirements are met.


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


• Assesses, analyzes and interprets financial risks and opportunities by using non-traditional actuarial methods and actuarial judgment when conducting actuarial analyses; and coaches and develops staff while ensuring business needs or requirements are met.


• 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; and coaches and develops staff while ensuring business needs or requirements are met.


• Creates framework and assumptions for new, existing, and non-traditional actuarial models to meet business needs; and coaches and develops staff while ensuring business needs or requirements are met.