Actuarial Analyst V Risk Adjustment

Kaiser Permanente; Oakland (CA); Remote; USD 166,000 - 215,000; Full time

Job summary

An established industry player is seeking an experienced Actuarial Analyst to enhance risk adjustment performance across Medicare Advantage and ACA populations. This role involves developing predictive models using clinical and claims data, while driving data-driven strategies to optimize financial outcomes. The ideal candidate will have a strong background in actuarial analysis, risk adjustment modeling, and collaboration with cross-functional teams. Join a firm committed to diversity and inclusion, where your expertise will shape the future of healthcare analytics.

Qualifications

• 8+ years of actuarial experience with a Bachelor's degree in Mathematics or related field.
• Certificates from Actuarial Societies are required.

Responsibilities

• Drive projects by influencing stakeholders and mentoring junior team members.
• Conduct business projects and develop work plans to meet priorities.
• Lead collaboration with business partners and translate actuarial constructs.

Skills

Actuarial Analysis

Risk Adjustment Modeling

Predictive Modeling

Data Interpretation

Financial Analysis

Education

Bachelor's degree in Mathematics

Associate of the Casualty Actuarial Society Certificate

Associate of the Society of Actuaries Certificate

Job description

This role will focus on advancing actuarial insights that improve risk adjustment performance across Medicare Advantage and ACA populations. Key areas of emphasis include HCC model analytics, forecasting of RAF scores, and the development of predictive models using clinical and claims data. The analyst will play a key role in shaping data-driven strategies to support accurate documentation, optimize financial outcomes, and inform enterprise decision-making. This is a highly collaborative and technical role that blends deep actuarial thinking with practical applications in government programs, population health, and revenue optimization.

Responsibilities include:

1. Practicing self-leadership and promoting learning in others by building relationships with cross-functional stakeholders; communicating information and providing advice to drive projects forward; influencing team members within the assigned unit; listening and responding to, seeking, and addressing performance feedback; adapting to competing demands and new responsibilities; providing feedback to others, including upward feedback to leadership and mentoring junior team members; creating and executing plans to capitalize on strengths and develop weaknesses; and learning from change, difficulties, and feedback.
2. Conducting or overseeing business-specific projects by applying deep expertise in the subject area; promoting adherence to all procedures and policies; developing work plans to meet business priorities and deadlines; determining and carrying out processes and methodologies; coordinating and delegating resources to accomplish organizational goals; partnering internally and externally to make effective business decisions; solving complex problems; escalating issues or risks as appropriate; monitoring progress and results; recognizing and capitalizing on improvement opportunities; and evaluating recommendations made by others.
3. Completing actuarial documentation by reviewing and coordinating the actuarial portion of financial reports and tax returns, and responses to insurance regulations; and presenting results internally to mid-level leadership.
4. Developing and designing product line evaluations by interpreting and communicating findings of analysis of product line financials, reserve, valuation, cash flow analysis; and interpreting product line performance, risk, and assumptions used in product development.
5. Designing and developing actuarial research by designing complex methods to advance standards, assumptions, and the legal and regulatory environment.
6. Assessing, analyzing, and interpreting financial risks and opportunities by using non-traditional actuarial methods and actuarial judgment when conducting analyses.
7. Leading collaboration with business partners by translating complex actuarial constructs into actionable recommendations; and developing and formulating accurate actuarial and financial advice in compliance with the Actuarial Standards of Practice.
8. Creating frameworks and assumptions for new, existing, and non-traditional actuarial models to meet business needs.

Minimum Qualifications:

• Bachelor's degree in mathematics or a related field AND at least eight (8) years of actuarial experience. Equivalent work experience in a related field may substitute for the degree.
• Associate of the Casualty Actuarial Society Certificate OR Associate of the Society of Actuaries Certificate.

Preferred Qualifications:

• Experience with Medicare Advantage, Risk Adjustment Part C and Part D HCC modeling and analytics, and predictive modeling using clinical data sets.
• Experience with ACA Risk Adjustment modeling and forecasting.

Primary Location: California, Oakland, Ordway

Additional Locations: East Annex - Parsons, Pasadena, OR, Rockville, MD

Scheduled Weekly Hours: 40

Shift: Day

Workdays: Mon-Fri

Working Hours End: 05:00 PM

Job Schedule: Full-time

Job Type: Standard

Worker Location: Remote

Employee Status: Regular

Employee Group / Union: NUE-PO-01|NUE|Non Union Employee

Job Level: Individual Contributor

Specialty: Actuarial Services

Pay Range: $166,100 - $214,940/year. Actual pay will depend on experience, education, and location.

Travel: Yes, 5% of the time

Remote Work: Work from home within authorized states, in accordance with Kaiser Permanente policies.

We are committed to diversity, equity, and inclusion, striving to create a supportive and respectful workplace environment.