Actuarial Consultant with Medicaid Experience

About This Role

This role involves providing strategic and technical actuarial consulting services to public sector clients, focusing on Medicaid reimbursement and policy. You will support engagement on actuarial rate development, budget forecasting, and risk adjustment, while also contributing to business development.

Responsibilities

• Provide strategic and technical consulting services to public sector clients
• Support 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
• Support business development efforts for Federal and State governments, employer groups, and other public entities
• 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

Requirements

• 2+ years of health actuary experience and consulting and/or health plan/insurance company experience
• 1+ year(s) of experience with Medicaid managed care capitation rate development and/or fee-for-service rate development
• Legally authorized to work in the United States without the need for employer sponsorship
• Exam progress towards ASA or FSA
• Bachelor's Degree

Qualifications

• Bachelor's Degree
• 2+ years of health actuary experience and consulting and/or health plan/insurance company experience; 1+ year(s) of experience with Medicaid managed care capitation rate development and/or fee-for-service rate development

Nice to Have

• ASA with progression to FSA, FSA, or career ASA designation
• 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
• Experience with reimbursement models - including value based care/ACO modeling
• Knowledge of group insurance products including disability, long term care, etc.

Skills

* Required skills