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Actuarial Risk Adjustment information

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$22K

$93.5K

$154K

How much do actuarial risk adjustment jobs pay per year?

As of Sep 10, 2026, the average yearly pay for actuarial risk adjustment in the United States is $93,525.00, according to ZipRecruiter salary data. Most workers in this role earn between $71,500.00 and $109,500.00 per year, depending on experience, location, and employer.

What is actuarial risk adjustment?

Actuarial risk adjustment is a process used primarily in health insurance to make financial adjustments based on the underlying health status and expected costs of insured populations. This method helps ensure that insurance plans are fairly compensated for taking on higher-risk individuals, preventing insurers from only enrolling healthier people. By analyzing data such as age, gender, and medical history, actuaries create models that predict healthcare costs, which are then used to adjust payments or premiums. This supports fairness and sustainability in insurance markets while promoting access to care for all risk groups.

What are the key skills and qualifications needed to thrive as an actuarial risk adjustment specialist, and why are they important?

To thrive as an Actuarial Risk Adjustment Specialist, you need strong analytical abilities, a solid foundation in mathematics, statistics, or actuarial science, and typically a relevant degree or actuarial exam progress. Familiarity with data analysis tools like SAS, SQL, or Python, as well as knowledge of risk adjustment models and healthcare payment systems, is crucial. Exceptional attention to detail, problem-solving skills, and effective communication help professionals interpret complex data and explain findings to diverse stakeholders. These competencies ensure accurate risk assessments, drive fair reimbursement, and support data-driven decision-making in healthcare finance.

What are some common challenges faced in actuarial risk adjustment roles, and how can they be addressed?

Professionals in Actuarial Risk Adjustment often encounter challenges such as managing large and complex datasets, keeping up with evolving regulatory requirements, and ensuring the accuracy of risk score calculations. These challenges can be addressed by staying current with industry regulations, leveraging advanced analytical tools, and collaborating closely with data scientists, underwriters, and compliance teams. Continuous professional development and strong communication skills are also key to effectively navigating this dynamic environment.

What is the difference between Actuarial Risk Adjustment vs Actuarial Data Analyst?

AspectActuarial Risk AdjustmentActuarial Data Analyst
Required CredentialsActuarial exams, ASA or FSA designationTypically a bachelor's degree, some actuarial exams
Work EnvironmentInsurance companies, healthcare payers, government agenciesInsurance firms, consulting, healthcare organizations
Industry UsageFocuses on adjusting risk models for fairness and accuracyAnalyzes data to support actuarial models and business decisions

Actuarial Risk Adjustment specialists focus on modifying risk models to ensure fairness and accuracy in healthcare or insurance payments, often requiring advanced actuarial credentials. In contrast, Actuarial Data Analysts primarily analyze data to support actuarial models and business strategies, usually with less emphasis on actuarial certification. Both roles work within similar environments but serve different functions within the industry.

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Actuarial Risk Adjustment jobs near you
Infographic showing various Actuarial Risk Adjustment job openings in the United States as of September 2026, with employment types broken down into 67% Full Time, and 33% Contract. Highlights an 33% In-person, 34% Hybrid, and 33% Remote job distribution, with an average salary of $93,525 per year, or $45 per hour.

Lead Actuarial Analyst, MA Risk Adjustment

Raleigh, NC • On-site

Strive Health
Health Care and Social Assistance • 501 - 1,000 employees
Learn more about Strive Healthexternal

$99K - $124K/yr

Full-time

Medical

Re-posted 13 days ago

Job description

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%

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