Actuarial Analytics Manager

Calling Actuarial Leaders! 

Phenom Consulting has partnered with a leading healthcare organization to grow their Actuarial team. We are seeking an Actuarial Analytics Manager with experience in the healthcare industry.

As Actuarial Manager, you will oversee and guide the organization’s Medicaid and Medicare programs. This role involves leading the review of capitation rate assumptions and methodologies, overseeing financial and encounter data submissions, providing expert consultation for Medicare bid processes, and evaluating financial performance. The ideal candidate will also maintain an understanding of evolving healthcare trends and regulations, and foster strong relationships with internal and external stakeholders.

What You’ll Do:

• Oversee Capitation Rates: Lead the analysis and review of capitation rate assumptions and methodologies for Medicaid.

• Data Submission Oversight: Manage the submission process for financial and encounter data to support Medicaid capitation rate setting.

• Medicare Expertise: Provide specialized knowledge and consultation to support Medicare bid processes and pricing strategies.

• Financial Performance Evaluation: Assess the financial outcomes for Medicaid and Medicare lines of business.

• Stay Informed: Keep abreast of changing healthcare trends, actuarial regulations, government regulations, guidance, analytic techniques, and data sources.

• Relationship Building: Develop and maintain strong relationships with leadership across various departments including Product, Finance, Regulatory, Pharmacy, as well as with external entities like CMS and provider groups.

• Team Leadership: Coach direct reports and set priorities for their tasks and projects.

What to Bring:

• Educational Background: Bachelor’s Degree in Statistics, Computer Science, Mathematics, Social Science, or a related field.

• Experience: Minimum of 5 years in healthcare actuarial roles with experience in Medicare Advantage pricing and bid development.

• Technical Skills: Proficiency in writing queries in SQL or other programming languages.

• Project Management: Proven ability to apply project management skills in data-related and financial analysis projects.

Preferred Qualifications

• Advanced Education: Master’s Degree in Statistics, Computer Science, Mathematics, Social Science, or a related field.

• Professional Certification: Fellow or Associate in the Society of Actuaries (FSA or ASA).

• Medicare Advantage Certification: Experience certifying Medicare Advantage Bids.

• Revenue Methodologies: Familiarity with Commercial, Medicare, and Medicaid revenue methodologies.

• Leadership Experience: Demonstrated ability to manage professional staff who independently handle tasks and projects.

What You’ll Get:

• Ability to work remote (must reside in California, Oregon, or Washington)

• Full suite of excellent benefits: medical, dental, well-being, retirement, and career development

• Play a key leadership role in a dynamic organization

• Industry leading salary and total compensation

If you’re an Actuarial Leader ready to take on a dynamic role with a leading organization, apply today for immediate consideration.