Actuary

Sustainable World, Inc.

Wilmington (NC)

Hybrid

USD 120,000 - 180,000

Full time

14 days+

Get more replies from employers

Send a job-specific resume in minutes.

Job summary

Wilmington Health is seeking an experienced Actuary to own actuarial, financial, and analytical work across ACA, Medicare, Medicaid, and other value-based care programs. The role requires ASA (or higher) and independent judgment with responsibility for conclusions.

The Actuary will analyze claims, cost trends, discount risk, and performance, partnering with finance, analytics, operations, and executive stakeholders to identify opportunities and inform strategic decisions.

Qualifications

Bachelor’s degree in actuarial science, statistics, economics, or a related quantitative field.
ASA credential required; FSA a plus.
3–5+ years of healthcare actuarial experience or equivalent.
Experience with healthcare data including claims, eligibility, and utilization.
Strong understanding of total cost of care, PMPM, risk scores, benchmarks, and results.
Working knowledge of Medicare, Medicaid, ACOs, and value-based contracts.
Advanced Excel and large data set experience.
SQL proficiency required; experience with SAS, Python, or R preferred.
Experience with Power BI, Tableau, or Looker for reporting.

Responsibilities

Analyze healthcare claims, eligibility, attribution, provider data for value-based care performance.
Develop and maintain total cost of care models and cost trend analyses.
Quantify impact of population changes on risk scores and benchmarks.
Evaluate performance by provider group, market, and contract.
Identify cost and utilization opportunities and care gaps.
Lead analyses for prospective partnerships or markets in value-based care.
Prepare forecasts, scenario analyses, and performance projections.
Communicate findings clearly to leadership and non-technical stakeholders.
Develop actuarial data structures, reporting processes, and repeatable tools.

Skills

Healthcare actuarial analysis

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

Executive-level reporting

Cross-functional collaboration

Technical problem-solving

Clear communication of complex quantti

Education

Bachelor's degree in actuarial science, mathematics, statistics, economics, finance, data science, healthcare analytics, or a related quantitative field.

Tools

SQL

SAS

Python

Excel

Power BI

Tableau

Looker

Job description

About Wilmington Health

Since 1971, Wilmington Health has been committed to the care and health of our community in Wilmington as well as all of southeastern North Carolina. Wilmington Health is structured as a multi-specialty medical practice with primary care providers integrated into the system. In this way, Wilmington Health is able to provide a comprehensive and coordinated approach to the care of all our patients. Wilmington Health is committed to using collaborative, evidence-based medicine in providing the highest quality of care to the patients we serve.

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: the individual is expected to hold an ASA (or higher) designation and to exercise independent actuarial judgment, with accountability for the soundness of their own work product.

This position is responsible for analyzing healthcare claims, utilization, cost trends, risk adjustment, attribution, benchmarks, shared savings/loss opportunities, and performance under value-based care models. The Actuary works cross-functionally with finance, analytics, operations, clinical leadership, contracting, and executive stakeholders to identify financial opportunities, evaluate risk, support strategic decision-making, and communicate complex actuarial concepts clearly and actionably.

This role requires strong technical skills, healthcare data experience, and the ability to independently conduct and finalize 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.

Essential Duties/Responsibilities:

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.
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.
Contributes 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
RequiredFrequency

Standing -Occasionally

Sitting - Continuously

Walking - Occasionally

Kneeling/Crouching - Rarely

Lifting -Rarely

Competencies