Actuary (CMS Regulatory & Bid Pricing)

Curana Health; Idaho; On-site; USD 120,000 - 180,000; Full time

Job summary

Curana Health is seeking a senior actuary to broaden impact beyond the numbers. You’ll lead CMS bid development, risk-adjustment modeling, and Part D pricing tasks while collaborating with finance, clinical, and leadership teams across a national platform.

Ideal candidates bring 5+ years of actuarial experience in healthcare, ASA certification, and strong skills in Excel, SAS, R, Python, and SQL. This role offers growth, visibility, and critical contributions to senior care delivery nationwide.

Qualifications

• Bachelor’s degree in Actuarial Science, Mathematics, Statistics, or related quantitative field.
• ASA (Associate of the Society of Actuaries) required.
• 5-8+ years of actuarial experience, healthcare or managed care settings preferred.
• Minimum 2 years of Medicare Advantage health plan experience (required).
• Hands-on experience with CMS bid development and HPMS submissions.
• Experience with risk adjustment modeling, HCC analysis, and CMS payment reconciliation.
• Advanced proficiency in Excel and actuarial modeling tools.
• Experience using CMS data systems (HPMS, MARx, RAPS/EDPS).

Responsibilities

• Lead CMS bid development and HPMS filings for Medicare Advantage plan years.
• Build and maintain IBNR reserve modeling and support monthly close and financial reporting cycles.
• Perform risk adjustment modeling, HCC analysis, and CMS payment reconciliation.
• Monitor and respond to CMS data systems including HPMS, MARx, and RAPS/EDPS.
• Support RADV audit preparation and encounter data quality review.
• Develop and maintain Part D pricing models and support reconciliation processes.
• Translate actuarial findings into clear, actionable insights for non-actuarial stakeholders.
• Partner cross-functionally with finance, clinical, compliance, and network teams.
• Manage multiple deliverables across competing deadlines including bid season and CMS filing cycles.

Skills

Analytical thinking

Healthcare actuarial experience

Medicare Advantage experience

Cross-functional collaboration

Excel modeling

Education

Bachelor's degree in Actuarial Science/related field

ASA designation

Tools

SAS

R

Python

SQL

Excel

HPMS

MARx

RAPS/EDPS

CMS bid development

Job description

At Curana Health, we’re on a mission to radically improve the health, happiness, and dignity of older adults—and we’re looking for passionate people to help us do it.

As a national leader in value-based care, we offer senior living communities and skilled nursing facilities a wide range of solutions (including on-site primary care services, Accountable Care Organizations, and Medicare Advantage Special Needs Plans) proven to enhance health outcomes, streamline operations, and create new financial opportunities.

Founded in 2021, we’ve grown quickly—now serving 200,000+ seniors in 1,500+ communities across 32 states. Our team includes more than 1,000 clinicians alongside care coordinators, analysts, operators, and professionals from all backgrounds, all working together to deliver high-quality, proactive solutions for senior living operators and those they care for.

If you’re looking to make a meaningful impact on the senior healthcare landscape, you’re in the right place—and we look forward to working with you.

For more information about our company, visit CuranaHealth.com

Summary

Looking for More Than a Traditional Actuarial Role?

This opportunity is designed for an Actuary who wants to broaden their impact beyond the numbers. We're seeking someone with a strong actuarial mindset who is curious, business-oriented, and excited to collaborate across functions to solve complex healthcare challenges. At Curana Health, you'll have the opportunity to expand your skill set, influence strategic decisions, and play a meaningful role in innovative initiatives that are helping transform care delivery for the senior population. If you're energized by learning, growth, and making a visible impact, this could be the next step in your career. This is a high-impact opportunity to partner cross-functionally with finance, clinical, compliance, and executive leadership in a rapidly growing, national organization.

Essential Duties & Responsibilities

• Lead CMS (Centers for Medicare & Medicaid Services) bid development and HPMS (Health Plan Management System) filings for Medicare Advantage plan years
• Build and maintain IBNR reserve modeling and support monthly close and financial reporting cycles
• Perform risk adjustment modeling, HCC analysis, and CMS payment reconciliation
• Monitor and respond to CMS data systems including HPMS, MARx, and RAPS/EDPS
• Support RADV audit preparation and encounter data quality review
• Develop and maintain Part D pricing models and support reconciliation processes
• Translate actuarial findings into clear, actionable insights for non-actuarial stakeholders
• Partner cross-functionally with finance, clinical, compliance, and network teams
• Manage multiple deliverables across competing deadlines including bid season and CMS filing cycles

What Success Looks like:

• Successfully support or lead the CMS bid submission cycle
• Deliver accurate, actionable insights from risk and financial modeling
• Strengthen reserve modeling and reporting processes
• Provide clear, executive-ready recommendations

Qualifications

Required Qualifications:

• Bachelor’s degree in Actuarial Science, Mathematics, Statistics, or related quantitative field
• ASA (Associate of the Society of Actuaries) required
• 5- 8+ years of actuarial experience, with a strong preference for healthcare or managed care settings
• Minimum 2 years of Medicare Advantage health plan experience (required)
• Hands‑on experience with CMS bid development and HPMS submissions
• Experience with risk adjustment modeling, HCC analysis, and CMS payment reconciliation
• Advanced proficiency in Excel and actuarial modeling tools
• Experience using SAS, R, Python, or SQL to analyze large healthcare datasets
• Experience working with CMS data systems (HPMS, MARx, RAPS/EDPS)

Preferred Qualifications:

• FSA and/or MAAA designation
• Experience with ISNP, D‑SNP, or dual‑eligible populations
• Part D pricing and/or reconciliation experience
• Exposure to RADV audits and encounter data processes