Finance- Senior Actuarial Analyst

ArchWell Health • Nashville, TN

10d

About The Position

The Senior Actuarial Analyst will play a pivotal role in ArchWell Health’s growth and within the Actuarial Department. This Analyst’s contribution will be key to the organization’s collective success. This role will work closely and collaboratively with various departments, providing insights that support strategic business decisions and optimize financial performance.

Requirements

• Prior experience within Medicare Advantage
• Understanding of CMS-HCC models (v24/v28), CMS risk adjustment methodology, and RAF score calculation
• Proficiency in modeling, forecasting, and/or variance analysis
• Advanced proficiency in Microsoft Excel
• Prior usage and strong understanding of SQL (2+ years preferred)
• Understanding of profit and loss statements and ability to work with larger datasets behind them
• Analytical, problem-solving, and critical thinking skills
• Ability to work effectively in a fast-paced, dynamic environment and managing multiple priorities simultaneously
• Strong interpersonal skills with the ability to collaborate cross-functionally and build positive working relationships at all levels of the organization.

Nice To Haves

• MBA or advanced degree preferred.
• 2+ Actuarial Exams, Pre-ASA or ASA level

Responsibilities

• Develop and maintain models to forecast risk-adjusted revenue across Medicare Advantage contracts
• Analyze historical risk score trends, RAF accuracy, and coding opportunities to identify gaps and performance drivers
• Support the annual budget process, quarterly projections, monthly accruals, and variance explanations
• Evaluate the impact of HCC model updates and CMS rule changes on organizational revenue
• Perform Ad-hoc Revenue Analysis to evaluate financial impacts of operational initiatives, clinical programs, membership shifts, and emergent business questions
• Assist in monthly IBNR development and selection process.
• Prepare necessary monthly reporting as a key contributor within the monthly closing cycle.
• Develop and maintain models to forecast future medical cost and revenue and/or evaluate the financial impact of various interventions.
• Partner with department heads to understand key business drivers and assumptions, ensuring alignment with strategic objectives.
• Prepare comprehensive financial reports and variance analyses for senior management and key stakeholders.
• Conduct ad hoc financial analyses to support special projects, strategic initiatives, and investment opportunities.
• Analyze payor healthcare data (claims, utilization, costs) to identify trends, cost drivers, and opportunities for improvement.
• End to end payor reconciliations (detail vs summary, external vs internal data feeds, and additional reconciliation as needed).
• Payor outreach and internal point of contact related to file requests, data gaps, and other supplemental reporting and information available
• Monitor and analyze key performance indicators (KPIs) and operational metrics to assess business performance and identify areas of improvement.
• Collaborate with operational teams to develop actionable insights and recommendations for performance enhancement and risk mitigation.
• Evaluate the cost-effectiveness and value of different healthcare interventions, programs, and policies.
• Assist in the development of executive-level dashboards and reporting tools to track financial and operational performance against targets.
• Collaborate cross-functionally with IT, finance, accounting, operations, and other departments to streamline processes, improve data accuracy, and enhance financial reporting capabilities.

Benefits

• ArchWell Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected classification.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior