Actuary

Wilmington Health PLLC; Wilmington (NC); On-site; USD 120,000 - 190,000; Full time

Job summary

Wilmington Health PLLC is seeking an Actuary to own actuarial, financial, and analytical work for value-based care programs including ACOs, Medicare/Medicaid, and commercial contracts. The role requires ASA (or higher) and independent judgment to ensure sound conclusions.

The incumbent will develop models for total cost of care, cost trends, risk adjustment, and shared savings projections, collaborating with finance, analytics, operations, and clinical leadership to drive strategic decisions.

Qualifications

• Bachelor's degree in actuarial science, mathematics, statistics, economics, finance, data science, healthcare analytics, or a related quantitative field.
• ASA credential required; FSA a plus.
• 3–5+ years of relevant experience in healthcare actuarial analysis, value-based care, health plan finance, provider finance, population health, or related work.
• Experience with healthcare data including claims, eligibility, provider, attribution, utilization, cost, quality, or risk adjustment data.
• Strong understanding of healthcare concepts such as total cost of care, PMPM, risk adjustment, attribution, benchmarks, and value-based care performance.
• Proficiency with Excel and SQL; experience with SAS, Python, R; familiarity with Power BI/Tableau/Looker preferred.

Responsibilities

• Own actuarial, financial, and analytical work related to healthcare value-based care arrangements including ACOs, Medicare/Medicaid, Medicare Advantage, and commercial risk contracts.
• Develop and maintain actuarial models for total cost of care, cost trends, utilization, risk adjustment, benchmarks, and shared savings/loss projections.
• Quantify impact of population changes, attribution, risk scores, benchmarks, rates, utilization, and medical cost trends.
• Evaluate performance by provider group, market, payor, contract, service line, site of care, and other segments.
• Identify medical cost and utilization opportunities and lead market analyses for value-based care partnerships.
• Prepare financial forecasts, scenario analyses, and performance projections for leadership.
• Monitor ongoing performance against budget, benchmarks, and contractual targets.

Skills

ASA credential

FSA preferred

Advanced Excel

SQL

SAS

Python

R

Power BI / Tableau / Looker

Education

Actuarial science or quantitative degree

Tools

SQL

SAS

Python

R

Power BI

Tableau

Looker

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Actuary

Accrues PDO • Wilmington, NC, US

Requisition ID: 3138

About Wilmington Health

Since 1971, Wilmington Health has been committed to the care and health of our community in Wilmington and all of Southeastern North Carolina. Wilmington Health is a multi-specialty medical practice with primary care providers integrated into the system to provide a comprehensive and coordinated approach to care. The organization uses collaborative, evidence-based medicine to deliver high-quality care.

Purpose

The Actuary will own actuarial, financial, and analytical work related to healthcare value-based care arrangements, including ACOs, Medicare, Medicaid, Medicare Advantage, commercial risk contracts, and other population health programs. This is a credentialed actuarial role requiring an ASA (or higher) designation and independent actuarial judgment, with accountability for the soundness of one\'s work product.

This position analyzes healthcare claims, utilization, cost trends, risk adjustment, attribution, benchmarks, shared savings/loss opportunities, and performance under value-based care models. The Actuary collaborates with finance, analytics, operations, clinical leadership, contracting, and executive stakeholders to identify financial opportunities, evaluate risk, support strategic decisions, and communicate complex actuarial concepts clearly.

The role requires strong technical skills, healthcare data experience, and the ability to independently conduct actuarial analysis in accordance with applicable Actuarial Standards of Practice (ASOPs) and the Code of Professional Conduct. The role carries professional responsibility for its own actuarial conclusions.

• Analyze medical claims, eligibility, attribution, provider, quality, and financial data to support value-based care performance evaluation.
• Develop and maintain actuarial models for total cost of care, medical expense trends, utilization, unit cost, risk adjustment, benchmark performance, and shared savings/loss projections across Medicare Shared Savings Program, ACO REACH, Medicare Advantage, Medicaid, commercial risk, and other value-based care arrangements.
• Quantify the impact of changes in population, attribution, risk scores, benchmarks, rates, utilization, and medical cost trends.
• Evaluate performance by provider group, cohort, market, payor, contract, service line, diagnosis category, site of care, and other relevant segments.
• Identify medical cost and utilization opportunities, including avoidable admissions, emergency department utilization, post-acute care, specialist spend, pharmacy trends, chronic condition management, and care gap opportunities.
• Lead opportunity analyses for prospective partners, participants, or markets entering value-based care arrangements.
• Prepare financial forecasts, scenario analyses, sensitivity analyses, and performance projections to inform leadership decisions.
• Lead the financial evaluation of value-based care arrangements, including shared savings terms, downside risk exposure, benchmark assumptions, stop-loss considerations, and administrative fee structures.
• Monitor ongoing performance against budget, benchmark, expected trend, and contractual targets.
• Support reconciliation analysis for value-based care programs, including earned savings, losses, quality adjustments, risk score changes, attribution changes, and benchmark updates.
• Analyze risk adjustment data, including HCC/RAF trends, coding patterns, demographic factors, disease burden, and documentation opportunities.
• Develop reports, dashboards, and executive summaries that translate actuarial findings into clear business insights for clinical, operational, financial, and executive audiences.
• Partner with analytics, IT, finance, operations, clinical, and business leaders to define data needs, gather requirements, validate assumptions, and communicate findings.
• Contribute to the development and maintenance of actuarial data structures, reporting processes, and repeatable analytical tools.
• Communicate trends, issues, risks, and opportunities to management and proactively recommend next steps.
• Support special projects requiring actuarial research, healthcare financial analysis, market analysis, or value-based care modeling.
• Maintain a working knowledge of healthcare regulations, CMS programs, payor methodologies, value-based care models, risk adjustment, claims data, and reimbursement structures.
• Continuously assess existing analytical processes and recommend improvements to increase accuracy, efficiency, scalability, and usefulness of reporting.
• Develop and maintain internal actuarial methodologies, documentation, and assumptions, consistent with professional actuarial standards.
• Serve as an informal mentor to junior analysts, interns, or team members on actuarial methods, healthcare data, and analytical best practices.
• Perform other healthcare actuarial, financial, and analytical duties as assigned.

Qualifications

Required Qualifications

• Bachelor\'s degree in actuarial science, mathematics, statistics, economics, finance, data science, healthcare analytics, or a related quantitative field.
• ASA (Associate of the Society of Actuaries) credential required; FSA a plus.
• 3–5+ years of relevant experience in healthcare actuarial analysis, value-based care, health plan finance, provider finance, population health, or related work.
• Experience working with healthcare data, including claims, eligibility, provider, attribution, utilization, cost, quality, or risk adjustment data.
• Strong understanding of healthcare concepts such as total cost of care, PMPM, utilization, unit cost, risk scores, benchmarks, attribution, medical expense trend, revenue cycle, and value-based care performance.
• Working knowledge of Medicare, Medicaid, Medicare Advantage, ACOs, and value-based care contracting models broadly.
• Advanced Excel skills and experience working with large datasets.
• Experience with SQL required.
• Experience with one or more analytical tools or programming languages such as SAS, Python, R, or similar platforms.
• Experience with reporting or data visualization tools such as Power BI, Tableau, Looker, or similar platforms preferred.
• Strong quantitative, analytical, and problem-solving skills.
• Ability to interpret complex data and communicate findings clearly to non-technical stakeholders.
• Strong written and verbal communication skills.
• Strong attention to detail and ability to independently validate data, assumptions, and model outputs.
• Ability to manage multiple priorities, meet deadlines, and work independently while collaborating across teams.
• Ability to work in a fast-paced, team-oriented healthcare environment with evolving priorities.

Preferred Qualifications

• FSA (Fellow of the Society of Actuaries) credential.
• Experience working at a health plan, provider group, ACO, CIN, MSO, population health organization, consulting firm, or healthcare analytics company.
• Experience with Medicare Shared Savings Program, ACO REACH, Medicare Advantage, Medicaid managed care, or commercial value-based care contracts.
• Experience analyzing CMS claims, payor claims, 837/835 files, attribution files, benchmark data, quality data, risk adjustment data, or reconciliation files.
• Experience developing financial opportunity analyses for value-based care partnerships or provider performance improvement.
• Experience leading actuarial modeling for shared savings, downside risk, stop-loss, trend, reserves, forecasting, or medical economics.
• Knowledge of HCC coding, RAF scoring, risk adjustment methodologies, quality measures, and CMS performance methodology.
• Experience building repeatable models, dashboards, and reporting packages for leadership review.

ADA Physical Demands

Rarely (Less than .5 hrs/day) Occasionally (0.6 – 2.5 hrs/day) Frequently (2.6 – 5.5 hrs/day) Continuously (5.6 – 8.0 hrs/day)

Physical Demand

Required?

Frequency

Standing

Occasionally

Walking

Occasionally

Kneeling/Crouching

Rarely

Lifting

Rarely

General

• Value-based care financial modeling
• Claims and utilization analysis
• Total cost of care analysis
• Medical expense trend analysis
• Risk adjustment and RAF analysis
• Benchmark and attribution analysis
• Shared savings/loss modeling
• Forecasting and scenario analysis
• Cross-functional collaboration
• Technical problem-solving
• Clear communication of complex quantitative findings