Medicare Risk Adjustment Chart Review Jobs in Georgia

Our Deloitte Human Capital team helps organizations create value through people performance. We work with clients to reimagine work, the workforce, and the workplace across the enterprise and to transform their HR functions with AI and emerging technology. With the rapid pace of change in today's world, you will help clients answer questions like: How do I access, develop, and motivate my workforce? What should my AI strategy be for the HR function? Do I have the right organization and culture to enable performance? Join our team to make work better for humans and humans better at work. 

The team

Deloitte's Government and Public Services (GPS) practice - our people, ideas, technology and outcomes-is designed for impact. Serving federal, state, & local government clients as well as public higher education institutions, our team of professionals brings fresh perspective to help clients anticipate disruption, reimagine the possible, and fulfill their mission promise.

Our Insights, Innovation, & Operate offering provides key aspects of our clients' businesses with technology, data, and deep technical and human capabilities. Innovates and delivers creative, industry-centric solutions that streamline work and accelerate speed-to-value. 

Work you'll do

As an Actuarial Manager, you will:

• Provide strategic and technical consulting services to public sector clients
• Lead engagements focused on Medicaid reimbursement, including actuarial rate development across managed care and fee-for-service, Medicaid policy, budget forecasting and fiscal analyses, and risk adjustment
• Lead and manage end-to-end business development efforts for Federal and State governments, employer groups, and other public entities, including proposal development and capture
• Participate in the transformation of the health care sector through innovative actuarial solutions, such as AI-driven solutions, development of frameworks inclusive of social drivers of health, and transition of payment models to value-based payment frameworks
• Address complex, ill-defined problems with strong technical and innovative approaches
• Apply business-oriented strategies to enhance client outcomes and solutions
• Collaborate with cross-functional teams to deliver comprehensive actuarial services
• Engage in continuous learning and adaptation to emerging health care trends and technologies

• Ability to work independently and collaborate as part of a team
• Effective written and verbal communication skills
• Meticulous attention to detail and quality of work product
• Ability to build and sustain professional relationships
• Ability to lead projects or workstreams
• Ability to manage and prioritize multiple tasks in a fast-paced and dynamic environment
• Strong interpersonal skills and professional demeanor
• Ability to meet deadlines
• Ability to mentor and provide clear guidance to others

Qualifications

Required:

• Bachelor's Degree required
• 10+ years of health actuary experience and consulting and/or health plan/insurance company experience
• 5+ years of experience with Medicaid managed care capitation rate development and/or fee-for-service rate development
• 1+ years of experience managing and leading teams OR 1+ years of experience managing and leading teams and leading business development efforts, including selling services to prospective and existing clients 
• ASA with progression to FSA or FSA
• Ability to travel 10-50% on average, based on the work you do and the clients and industries/sectors you serve
• Must be legally authorized to work in the United States without the need for employer sponsorship, now or at any time in the future

Preferred:

• Prior business development experience, preferably for state/local government clients
• Experience providing Medicaid consulting services to Government agencies
• Experience with Medicaid waivers (i.e., 1115, 1915 b/c, 1332)
• Experience with risk adjustment mechanisms
• Experience with Provider reimbursement streams (i.e., DSH, UPL, etc.)
• Experience with health care reform and working knowledge of the individual medical and small group markets 
• Experience with Medicare products, including Medicare Advantage or Medicare Supplement products for various enrollee types
• Familiarity with group insurance products including disability, long term care, etc.
• Experience with product design and/or product strategy
• Experience with reimbursement models - including value-based care/ACO modeling
• Experience understanding trends in the marketplace

The wage range for this role takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the position may be filled. At Deloitte, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range is $148,200 to $292,300.

You may also be eligible to participate in a discretionary annual incentive program, subject to the rules governing the program, whereby an award, if any, depends on various factors, including, without limitation, individual and organizational performance.

Our Deloitte Human Capital team helps organizations create value through people performance. We work with clients to reimagine work, the workforce, and the workplace across the enterprise and to transform their HR functions with AI and emerging technology. With the rapid pace of change in today's world, you will help clients answer questions like: How do I access, develop, and motivate my workforce? What should my AI strategy be for the HR function? Do I have the right organization and culture to enable performance? Join our team to make work better for humans and humans better at work. 

The team

Deloitte's Government and Public Services (GPS) practice - our people, ideas, technology and outcomes-is designed for impact. Serving federal, state, & local government clients as well as public higher education institutions, our team of professionals brings fresh perspective to help clients anticipate disruption, reimagine the possible, and fulfill their mission promise.

Our Insights, Innovation, & Operate offering provides key aspects of our clients' businesses with technology, data, and deep technical and human capabilities. Innovates and delivers creative, industry-centric solutions that streamline work and accelerate speed-to-value. 

Work you'll do

As an Actuarial Manager, you will:

• Provide strategic and technical consulting services to public sector clients
• Lead engagements focused on Medicaid reimbursement, including actuarial rate development across managed care and fee-for-service, Medicaid policy, budget forecasting and fiscal analyses, and risk adjustment
• Lead and manage end-to-end business development efforts for Federal and State governments, employer groups, and other public entities, including proposal development and capture
• Participate in the transformation of the health care sector through innovative actuarial solutions, such as AI-driven solutions, development of frameworks inclusive of social drivers of health, and transition of payment models to value-based payment frameworks
• Address complex, ill-defined problems with strong technical and innovative approaches
• Apply business-oriented strategies to enhance client outcomes and solutions
• Collaborate with cross-functional teams to deliver comprehensive actuarial services
• Engage in continuous learning and adaptation to emerging health care trends and technologies

• Ability to work independently and collaborate as part of a team
• Effective written and verbal communication skills
• Meticulous attention to detail and quality of work product
• Ability to build and sustain professional relationships
• Ability to lead projects or workstreams
• Ability to manage and prioritize multiple tasks in a fast-paced and dynamic environment
• Strong interpersonal skills and professional demeanor
• Ability to meet deadlines
• Ability to mentor and provide clear guidance to others

Qualifications

Required:

• Bachelor's Degree required
• 10+ years of health actuary experience and consulting and/or health plan/insurance company experience
• 5+ years of experience with Medicaid managed care capitation rate development and/or fee-for-service rate development
• 1+ years of experience managing and leading teams OR 1+ years of experience managing and leading teams and leading business development efforts, including selling services to prospective and existing clients 
• ASA with progression to FSA or FSA
• Ability to travel 10-50% on average, based on the work you do and the clients and industries/sectors you serve
• Must be legally authorized to work in the United States without the need for employer sponsorship, now or at any time in the future

Preferred:

• Prior business development experience, preferably for state/local government clients
• Experience providing Medicaid consulting services to Government agencies
• Experience with Medicaid waivers (i.e., 1115, 1915 b/c, 1332)
• Experience with risk adjustment mechanisms
• Experience with Provider reimbursement streams (i.e., DSH, UPL, etc.)
• Experience with health care reform and working knowledge of the individual medical and small group markets 
• Experience with Medicare products, including Medicare Advantage or Medicare Supplement products for various enrollee types
• Familiarity with group insurance products including disability, long term care, etc.
• Experience with product design and/or product strategy
• Experience with reimbursement models - including value-based care/ACO modeling
• Experience understanding trends in the marketplace

The wage range for this role takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the position may be filled. At Deloitte, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range is $148,200 to $292,300.

You may also be eligible to participate in a discretionary annual incentive program, subject to the rules governing the program, whereby an award, if any, depends on various factors, including, without limitation, individual and organizational performance.