Senior Actuarial Analyst

Position Summary

We are seeking a Senior Actuarial Analyst to support Medicaid and Value-Based Care (VBC) initiatives through advanced actuarial analysis, financial modeling, and healthcare analytics. This individual will play a key role in evaluating population health performance, monitoring financial outcomes, and driving data-informed decision making across value-based programs. The ideal candidate will bring a strong analytical background, hands-on SQL experience, and deep knowledge of healthcare financial metrics including PMPM and MLR.

Key Responsibilities

• Analyze Medicaid populations and value-based care arrangements to identify cost, utilization, and quality trends.
• Develop and maintain financial models supporting VBC programs, capitation arrangements, shared savings initiatives, and risk-based contracts.
• Perform PMPM (Per Member Per Month) analyses to evaluate healthcare cost drivers and support forecasting activities.
• Monitor and analyze Medical Loss Ratio (MLR) performance, providing actionable insights to leadership and operational teams.
• Utilize SQL to extract, manipulate, and analyze large healthcare datasets from multiple sources.
• Support actuarial forecasting, budgeting, and financial planning processes.
• Develop reporting and dashboards that track financial, operational, and population health performance metrics.
• Collaborate with Clinical, Network, Finance, Population Health, and Analytics teams to evaluate program effectiveness and identify opportunities for improvement.
• Conduct ad hoc analyses related to cost containment, utilization management, risk adjustment, and provider performance.
• Present findings and recommendations to stakeholders in a clear and concise manner.

Qualifications

• Bachelor's degree in Actuarial Science, Mathematics, Statistics, Economics, or a related quantitative field.
• 3+ years of actuarial or healthcare analytics experience, preferably within Medicaid, managed care, or value-based care environments.
• Progress toward ASA designation preferred.
• Advanced SQL skills with experience working with large healthcare claims and membership datasets.
• Experience performing PMPM cost analysis, trend studies, forecasting, and financial performance reporting.
• Strong understanding of MLR, healthcare economics, and actuarial principles.
• Experience supporting Value-Based Care programs such as MSSP, ACOs, shared savings arrangements, capitation, or other risk-based contracts preferred.
• Proficiency with Excel and data visualization tools such as Power BI, Tableau, or similar platforms.
• Excellent analytical, problem-solving, and communication skills.

Preferred Experience

• Medicaid managed care experience.
• Knowledge of provider contracting, population health, and quality performance metrics.
• Experience working with healthcare claims, encounter, pharmacy, and membership data.
• Exposure to risk adjustment, forecasting, and financial modeling in a VBC environment.

This role offers the opportunity to directly influence Medicaid and Value-Based Care strategy through sophisticated actuarial analysis, financial modeling, and data-driven insights.