Hcc Risk Adjustment Jobs in Virginia (NOW HIRING)

We are seeking an experienced Actuary (5+ years of experience) for our value-based care (VBC) team. This role requires a seasoned professional in medical economics, actuarial, or equivalent data analytics experience who can navigate the complex landscape of Medicare risk models, value-based care arrangements, and population health analytics. The ideal candidate will play a critical role in optimizing our organization's performance under CMS total cost of care models while ensuring sustainable financial outcomes. Candidates will ideally have their ASA certification or have passed at least the first three exams.

This role is currently scoped as an individual contributor, with a growth trajectory toward leadership over time.

• Analyze VBC performance under various CMS and CMMI total cost-of-care models.
• Monitor and forecast financial performance across assigned patient populations.
• Conduct comprehensive claims analysis using CCLF (Claims and Claims Line Feed) and BCDA (Beneficiary Claims Data API) datasets.
• Refine key reporting and projection methodologies, including IBNR and Risk Score projections.
• Process and analyze large healthcare datasets, combining multiple data sources including EHR systems and Medicare claims data.
• Ensure data quality and integrity across all analytical processes.
• Develop and maintain SQL-based data structures to support population experience studies and VBC program analytics.

• Create fit-for-purpose analytical reports that translate complex actuarial findings into actionable business insights.
• Develop executive dashboards and performance metrics aligned with organizational strategic goals.
• Present findings and recommendations to leadership teams and clinical stakeholders.
• Support budget planning and financial forecasting processes.

• Stay current with evolving CMS and CMMI program requirements and quality measures.

• Bachelor's degree in Actuarial Science, Statistics, Mathematics, Data Science, or related quantitative field
• ASA credentials preferred for Actuarial candidates

• Strong healthcare data analytics experience in Medicare-focused or Medicare Advantage environments (5+ years of experience)
• Thorough understanding of and hands-on experience with Medicare risk adjustment and CMS-HCC models
• Experience working with CMS and CMMI total cost of care (ACO) programs
• Proven track record spearheading claims analytics using Medicare claims data
• In-depth knowledge of healthcare billing processes from both provider and CMS perspectives

• Advanced proficiency in Microsoft Excel and model building
• Strong SQL skills with the ability to write complex queries
• Experience with the Microsoft Azure cloud platform and related analytics tools preferred
• Experience with integrating data across multiple large, nuanced data sources (e.g., integration of EHR data with claims datasets)
• Experience developing/integrating AI-forward workflows into analytics

• Exceptional analytical and problem-solving capabilities
• Strong business acumen with the ability to translate technical findings into strategic recommendations
• Excellent written and verbal communication skills for both technical and non-technical audiences
• Proven team player with a collaborative approach to cross-functional projects
• Demonstrated capability to understand and respond to evolving business needs

• The salary range is $150- 170k with a $30- 40k bonus range