Job Description:
• Lead actuarial engagements for state Medicaid agencies and other public health clients
• Design and oversee encounter data analytics, validating completeness and accuracy
• Produce utilization trend analyses and reconcile encounter data to financial data for managed care oversight
• Develop and certify actuarially sound Medicaid managed care capitation rates, including risk adjustment methodologies
• Develop and apply risk scoring methodologies for capitation rate rebalancing, individual risk scores, and risk-adjusted settlements
• Conduct financial analyses and modeling for HCBS, LTSS, and PACE programs
• Provide strategic guidance on program design, waiver development and submission support, and value-based payment models
• Support federal authority activities, including cost-effectiveness and budget-neutrality analyses for waivers, state plan amendments, directed payments, and provider tax programs
• Conduct fiscal and policy impact analyses, including rate modifications, hospital rebasing, UPL/GME payments, and pay-for-performance calculations
• Collaborate with underwriters, policy experts, data analysts, health economists, and clinical consultants
• Present complex actuarial findings to clients, stakeholders, and regulatory bodies
• Mentor junior actuarial staff and contribute to professional development initiatives
• Stay current with federal and state regulations, CMS guidance, and emerging commercial and public health trends
Requirements:
• FSA or ASA with active membership in the American Academy of Actuaries (required)
• 15+ years of health actuarial experience
• At least 5 years supporting or employed by a state Medicaid agency
• Demonstrated ability to lead a team of actuaries
• Experience developing actuarially sound managed care capitation rates
• Experience with risk adjustment methodologies and waiver cost-effectiveness models
• Deep familiarity with CMS review processes, federal regulatory standards, and ASOP compliance
• Expertise with Medicaid and commercial claims/encounter data, including APCDs and MMIS
• Excellent communication skills and a strong record of producing defensible actuarial documentation
• Executive presence and strong client relation skills
• Ability to work in a collaborative environment
• Advanced skills in Microsoft Excel, Word, and PowerPoint
• Experience providing expert testimony or support in rate hearings and rate negotiations preferred
• Desire to generate new business strongly preferred
Benefits:
• Benefits supporting physical, mental, career, social, and financial well-being
• Potential for growth and advancement
• Professional development initiatives
• Minimal travel, less than 20% per year
• Reasonable accommodation for the job application, interview process, or essential job functions