Lead development, validation, and optimization of Medicare Advantage revenue and risk-adjustment projection models. Analyze MA data (MMR, MAO-004, claims), assess bidding and rebate impacts, benchmark market performance, collaborate with stakeholders to onboard payers, prepare audit documentation, and deliver actionable insights to senior leadership while growing and managing actuarial talent.
Company:AHI agilon health, inc.Job Posting Location:Remote - USAJob Title: Actuarial Manager, MA Revenue AnalyticsJob Description:
This position is not eligible for current or future sponsorship or employer-supported work authorization by agilon health. Applicants must be able to accept and maintain employment with agilon health in the United States for the full duration of their employment without sponsorship or work authorization support.
The Actuarial Manager, MA Revenue Analytics is responsible for leading the development, validation, and optimization of models and analytics that support accurate revenue forecasting for agilon’s Medicare Advantage (MA) population. Models will incorporate CMS and health plan provided data as well as operational leading indicators. Results will be used for budgeting, forecasting, contracting, and monthly booking activities.
Essential Job Functions:• Build upon existing processes to create standardized MA risk adjustment projection models• Evaluate operational leading indicators and connection to actuarial projections• Influence BOI (Burden of Illness)-based operational leading indicators• Benchmark market performance and identify areas for opportunity• Investigate differences in health plan risk adjustment coding practices using MAO-004 data• Summarize YoY changes in MA bid rates/rebates and evaluate impact to agilon’s book of business• Assess health plan MA bid strategies and partner with payer contracting/other stakeholders to mitigate risks• Educate internal stakeholders on the health plan MA bidding process and risk adjustment where necessary to appropriately deliver results• Provide actionable insights and recommendations to senior leadership based on actuarial analyses• Collaborate with Payer Data Management to onboard new revenue-only MA payers in the FDP (Financial Data Pipeline)• Prepare internal/external audit documentation• Support build-out of improved actuarial team processesOther Job Functions:· Grow and lead talent· Exemplify companies’ core values· Collaborate with Market Finance, FP&A, Accounting, Med Econ, and othersRequired Qualifications:
Minimum Experience
• 5+ years of actuarial experience related to the Medicare Advantage program
• Demonstrated leadership capability, has previously led others
Education/Licensure
• ASA or FSA designation
• Bachelor’s degree in Actuarial Science, Math, Economics or related field
Knowledge, Skills, and Abilities:
• Excellent communication, both written and verbal
• Strong understanding of MA revenue components
• Understanding of MA health plan data (MMR, MAO-004, Claims etc.)
• Deep understanding of MA risk adjustment and bidding process
• Experience with value-based arrangements is a plus
• Proficiency with Excel and SQL
• Strong model building mindset; model flow, ease of use, auditability, etc.
• Proven ability to work in a fast-paced environment where internal/external client satisfaction is key
• Experience presenting actuarial/financial concepts to a non-technical audience
• Proven problem-solving skills (identification of issue, causes, solution, implementation plan) • Proven ability to influence, grow, and motivate others
• Entrepreneurial and innovative spirit
Essential Physical Functions:
These are requirements normally expected to perform regular job duties. Incumbent must be able to successfully perform all the functions of the job with or without accommodation.
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Location: Remote - MNPay Range: $129,700.00 - $162,100.00Salary range shown is a guideline. Individual compensation packages can vary based on factors unique to each candidate, such as skill set, experience, and qualifications.
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