Director of Actuarial Analytics and Insights

Reveleer

1d•$150,000 - $185,000•Remote

About The Position

Reveleer is hiring a senior actuary to lead health plan and risk adjustment analytics for each line of business for Reveleer customers across Medicare Advantage (MA), Medicare Prescription Drug (MAPD), Affordable Care Act (ACA), Medicaid, and provider value-based contracts. This role builds member-level actuarial models that quantify risk adjustment performance, HCC (Hierarchical Condition Category) capture, medical economics, utilization, and population health trends, and translates those models into customer-facing dashboards that inform pricing, forecasting, and program strategy. This actuary works directly with customer success, analytics, product, operations, and clinical teams to convert raw claims, encounter, member, provider, and clinical data into decision-ready outputs. The role requires both technical model-building skill and the ability to explain actuarial and risk adjustment concepts to non-actuarial stakeholders, including provider and health plan executives.

Requirements

Seven or more years of actuarial or actuarial-adjacent analytics experience in health plan pricing, risk adjustment, or medical economics.
Direct pricing or performance modeling experience across at least three of the following: Medicare Advantage, MAPD, ACA, Medicaid, and value-based contracts.
Working knowledge of the CMS-HCC and ACA risk model, RAF score calculation, and the relationship between ICD-10 diagnosis coding and risk adjustment revenue.
Demonstrated experience building member-level data models that feed reporting or dashboard tools, such as Tableau or Power BI.
Proficiency in SQL and at least one statistical or scripting language, such as SAS, R, or Python.
Proficiency in utilizing AI tools to support modeling
Bachelor's degree in actuarial science, mathematics, statistics, economics, or a related quantitative field.
Strong written and verbal communication skills, with experience presenting actuarial findings to executive audiences.

Nice To Haves

Associate of the Society of Actuaries (ASA) designation or Fellowship (FSA) or progress toward.
Experience with CMS files, including the MMR, MOR, MAO-004, and Beneficiary-Level file.
Experience with EDPS & EDGE encounter submissions and encounter data quality processes.
Prior experience supporting RADV & IVA audit readiness or chart review prioritization.
Familiarity with provider incentive program design tied to chronic HCC recapture or quality performance.
Experience with financial forecasting, including ACA transfer payments and MA settlement accruals

Responsibilities

Build and maintain member-level actuarial models covering risk adjustment (RAF) performance, HCC capture and recapture, medical economics, utilization patterns, and population health metrics across MA, MAPD, ACA, and Medicaid populations.
Develop analytics that can support rate-setting for Medicare Advantage Bids, ACA rate filings, Medicaid capitation arrangements, and value-based contract terms.
Reconcile RAF calculations against source files, including the Monthly Membership Report (MMR), Model Output Report (MOR), MAO-004, and the Beneficiary-Level file, and extend that reconciliation logic into customer-facing reporting.
Design the actuarial and analytic logic behind customer-facing dashboards, partnering with data engineering and product teams to translate member-level models into usable, accurate, and timely visualizations.
Produce forecasting and accrual models that support midyear and final settlement estimates, transfer payments, capital planning, and financial reporting for risk adjustment programs.
Analyze utilization trends, medical loss ratio (MLR) drivers, and cost-of-care patterns to identify actionable opportunities for customers managing value-based contracts.
Support MA and HHS RADV (Risk Adjustment Data Validation) readiness by modeling audit exposure and prioritizing chart review and coding efforts based on financial impact.
Communicate model methodology, assumptions, and results clearly to actuarial and non-actuarial audiences, including customer executives.
Partner with clinical, coding, retrieval, and provider engagement teams to align analytic outputs with chronic HCC recapture, care gap closure, and quality initiatives.