Actuary – Medicare Stars & Quality (Hybrid/Remote)

Highmark Health; Northern (KY); Hybrid; USD 103,000 - 165,000; Full time

Job summary

Highmark Inc. is seeking an ASA-certified actuary to lead development of advanced actuarial models forecasting Medicare Advantage Star Ratings. The role analyzes data from claims, enrollment, clinical data, HEDIS and CMS sources and guides decision-making.

Mentors staff and collaborates across teams to ensure accurate, compliant results. The position emphasizes cross-functional communication, problem solving, and adherence to corporate goals while driving quality improvements within Medicare

Qualifications

• Requires 5 years actuarial experience in area of specialization.
• ASA certification required; FSA preferred.

Responsibilities

• Define and diagnose a problem; outline data requirements for studies and devise solutions.
• Initiate and lead studies, analyses and presentation materials for decision makers.
• Mentor less experienced staff and provide technical input across teams.
• Represent department perspectives in cross-disciplinary settings and negotiate solutions.

Skills

Actuarial analysis

Model development

Leadership

Cross-functional collaboration

Communication

Education

Bachelor's degree in Actuarial Science, Mathematics, Statistics or closely related field

Job description

Highmark Inc. is seeking an ASA-certified actuary to lead development of advanced actuarial models forecasting Medicare Advantage Star Ratings. The role analyzes data from claims, enrollment, clinical data, HEDIS and CMS sources and guides decision-making.

Mentors staff and collaborates across teams to ensure accurate, compliant results. The position emphasizes cross-functional communication, problem solving, and adherence to corporate goals while driving quality improvements within Medicare