Remote Senior Actuary, Health Plan Analytics

Reveleer; United States; On-site; USD 140,000 - 190,000; Full time

Benefits offered by this job

Medical, Dental and Vision benefits

401k match

Generous PTO plan

Job summary

Reveleer is seeking a senior actuary to lead health plan analytics across MA, MAPD, ACA, Medicaid, and provider value-based contracts. You will build member-level models that quantify risk adjustment performance and HCC capture, translate results into customer dashboards, and inform pricing, forecasting, and program strategy.

This role requires communicating complex actuarial concepts to executives and collaborating with customer success, analytics, product, and clinical teams to drive

Qualifications

• Seven or more years of actuarial or actuarial-adjacent analytics experience in health plan pricing, risk adjustment, or medical economics.
• Direct pricing or performance modeling experience across at least three of the following: Medicare Advantage, MAPD, ACA, Medicaid, and value-based contracts.
• Working knowledge of the CMS-HCC and ACA risk model, RAF score calculation, and the relationship between ICD-10 coding and risk adjustment revenue.
• Experience building member-level data models that feed reporting or dashboards (Tableau/Power BI).
• Proficiency in SQL and at least one statistical or scripting language (SAS, R, or Python).
• Proficiency in utilizing AI tools to support modeling.
• Strong written and verbal communication skills with executives.

Responsibilities

• Build and maintain member-level actuarial models covering risk adjustment performance and HCC capture across MA, MAPD, ACA, and Medicaid.
• Develop analytics to support rate-setting for MA bids, ACA rate filings, Medicaid capitation, and value-based contracts.
• Reconcile RAF calculations against source files and extend this logic into customer-facing reporting.
• Design actuarial and analytic logic behind customer dashboards in collaboration with data engineering and product teams.
• Produce forecasting and accrual models supporting midyear and final settlement estimates and financial reporting.
• Analyze utilization trends and MLR drivers to identify actionable opportunities for value-based contracts.
• Support RADV readiness by modeling audit exposure and prioritizing chart review based on financial impact.

Skills

Actuarial modeling

Communication to executives

Cross-functional collaboration

Healthcare pricing knowledge

Statistical analysis

Education

Bachelor's degree in actuarial science, mathematics, statistics, economics, or related

Tools

SAS

SQL

Tableau/Power BI

Python/R

Job description

Reveleer is seeking a senior actuary to lead health plan analytics across MA, MAPD, ACA, Medicaid, and provider value-based contracts. You will build member-level models that quantify risk adjustment performance and HCC capture, translate results into customer dashboards, and inform pricing, forecasting, and program strategy.

This role requires communicating complex actuarial concepts to executives and collaborating with customer success, analytics, product, and clinical teams to drive