Lead Actuarial Analyst, MA Risk Adjustment

Strive Health Services LLC; Pittsburgh (Allegheny County); Hybrid; USD 99,000 - 124,000; Full time

Benefits offered by this job

Hybrid-Remote Flexibility

Comprehensive Benefits

Financial & Retirement Support – 401k

Time Off & Leave

Wellness & Growth

Job summary

Strive Health Services LLC is seeking a Lead Actuarial Analyst to join a high-performing team focused on risk adjustment analytics and financial performance. You will translate data into actionable insights, evaluate CMS data, and model scenarios to guide strategic decisions across clinical and financial domains.

Ideal candidates have 4+ years in risk adjustment analytics, actuarial exams, and strong Excel/SQL skills, with PBI/Redshift/dbt as pluses.

Qualifications

• 4+ years in risk adjustment analytics.
• 4+ years analyzing MMR, MOR, MAO-004 and medical claims data.
• 3+ actuarial exams passed.
• Proficient in Excel and SQL.
• Experience with PBI, Redshift, dbt docs is a plus.
• Bachelor’s degree in quantitative/health field.

Responsibilities

• Translate RA performance data into financial insights.
• Analyze CMS data to identify efficiency opportunities.
• Interpret trends, model scenarios, and assess program impacts.
• Link operational performance to enterprise financial outcomes.
• Perform end-to-end reconciliation from submissions to CMS acceptance and RAF leakage.
• Develop business cases and target metrics for investments.
• Prepare and deliver reports to senior leadership.

Skills

Analytical

Ownership

Communication

Ambiguity management

Education

Bachelor's degree in a quantitative or health-related field

Tools

Excel

SQL

PBI

Redshift

dbt docs

Job description

How You'll Make An Impact

At Strive Health, patients come first. We’re on a mission to transform chronic conditions by identifying risk earlier, coordinating thoughtful care, and supporting people through every stage of their health journey.

Our work reduces emergency visits, improves outcomes, and helps patients live fuller lives. You’ll work alongside passionate Strivers who care deeply about making an impact, show up for one another as One Team, and find ways to elevate the everyday.

If you’re looking for meaningful work where your contributions truly matter, you’ll feel right at home at Strive!

Benefits & Perks

• Hybrid-Remote Flexibility – Work from home while fulfilling in-person needs at the office, clinic, or patient home visits.
• Comprehensive Benefits – Medical, dental, and vision insurance, employee assistance programs, employer-paid and voluntary life and disability insurance, plus health and flexible spending accounts.
• Financial & Retirement Support – Competitive compensation with a performance-based bonus program, 401k with employer match, and financial wellness resources.
• Time Off & Leave – Paid holidays, vacation time, sick time, and paid birth-giving, bonding, sabbatical, and living donor leaves.
• Wellness & Growth – Family forming services through Maven Maternity at no cost and physical wellness perks, mental health support, and an annual professional development stipend.

What You’ll Do

We are seeking a Lead Actuarial Analyst, MA Risk Adjustment to join our high-performing, insights-driven team. You will play a critical role in evaluating financial performance, uncovering areas of opportunity, and use your 3+ actuarial exam progress to help translate complex data into actionable strategies. Your work will directly influence how Strive supports patients, clinicians, and markets in achieving both clinical and financial success. (This position is internally titled Lead Analyst, Risk Adjustment Analytics). We offer a competitive Actuarial Study Program designed to help you succeed, including exam fee support, study resources, and rewards for passing exams and achieving actuarial credentials.

Essential Functions

• Translate RA performance data into clear financial insights (i.e. revenue impact, payment accuracy, ROI, forecasting).
• Analyze CMS data to identify areas of opportunity to increase operational efficiency.
• Interpret trends, model scenarios, and assess program and policy impacts.
• Enable data-driven decisions by linking operational performance to enterprise financial outcomes.
• Perform end-to-end reconciliation from submissions to CMS acceptance, RAF leakage, and implement controls.
• Develop business cases to assess opportunity, determine target metrics, and provide data driven insights to support investment decisions (i.e. staffing, tech, etc.).
• Prepare and deliver clear and concise reports, presentations, and recommendations to senior leadership, illustrating the findings and implications of analyses conducted.

Who You Are

• A highly analytical problem-solver with a strong sense of ownership and intellectual curiosity.
• Able to manage a high volume of recurring and ad hoc deliverables without compromising quality.
• Comfortable navigating ambiguity and bringing structure to complex problems.
• An exceptional communicator who can translate technical findings into actionable business recommendations.

Qualifications

• 4+ years of experience in risk adjustment analytics.
• 4+ years of experience analyzing MMR, MOR, MAO-004 and medical claims data.
• 3+ actuarial exams passed.
• High degree of proficiency in Microsoft Excel and SQL.
• Experience with PBI, Redshift, dbt docs is a plus.
• Bachelor’s degree in a quantitative or health-related field (e.g., Economics, Public Health, Statistics, Health Services Research, Math, Finance).

Annual Salary Range: $99,000 - $124,000. This position is also eligible for a target annual bonus of 10%.

Final compensation will be determined based on location, experience, and qualifications.

Strive Health is an equal opportunity employer and drug free workplace. At this time Strive Health is unable to provide work visa sponsorship. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law. If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to [e-mail].

We do not accept unsolicited resumes from outside recruiters/placement agencies. Strive Health will not pay fees associated with resumes presented through unsolicited means.