Actuarial Manager (Lead Actuarial Consultant)

How will this role have an impact?

Signify Health/CVS Accountable Care is seeking a highly motivated and experienced actuary to join our fast-growing organization. The actuary will be a lead person on the CVS Accountable Care team that analyzes various sources of patient health and claims data to drive business impact for partners (MSSP, ACO REACH, Medicare Advantage, etc.).

The successful candidate will have thorough knowledge of and deep expertise in working with large Medicare claims dataset, conducting actuarial and risk adjustment (CMS-HCC) analysis. In addition, the position will lead and manage a wide range of projects.

What will you do?

• Develop strategies to drive performance for our partners and ACOs through the use of actuarial and advanced analytics techniques
• Proactively identify areas of opportunities for improvement and actionable insights for our partners and our ACOs using claims and real-time data.
• Evaluate the impact of Medicare quality and risk adjustment program has on our MA risk contracts and ACOs (MSSP and ACO REACH), including but not limited to risk adjustment opportunities, HCC gaps, and benchmarking analysis.
• Build models to help CVS Accountable Care identify areas to improve utilization of healthcare services
• Develop the appropriate level of reserves and analyze claims completion patterns for our ACOs
• Conduct descriptive and predictive analyses to identify opportunities to target population health interventions, improve care delivery, contribute to product and services development, and inform CVS Accountable Care's growth strategy
• Analyze various sources of patient care and claims data, including 100% Medicare data or VRDC, to provide actionable insights to stakeholders
• Get up to speed on our data model and make recommendations for changes to improve the accuracy and efficiency of the monthly claims completion process
• Proactively identify and communicate issues affecting a project plan
• Prepare comprehensive documented observations, analyses and interpretations of results including technical reports, summaries and quantitative analyses
• Present analysis results to internal and external audiences, including company executives, subject matter experts, delivery teams, and clinical teams within Signify Health/ CVS Accountable Care

We are looking for someone with:

• Bachelor's Degree or higher in Mathematics, Statistics, Actuarial Science or closely related field.
• Attained Associate of the Society of Actuaries (ASA) or Fellowship of the Society of Actuaries (FSA) designation.
• 8-15 years of relevant industry experience in one or more of the following areas:
  • Medicare Advantage, ACO, MSSP, ACO REACH
  • Healthcare Economics
  • Pricing
  • Reserving
  • Forecasting
  • Data Analytics
• Strong SQL, SAS, Python, or R skills, ability to perform effective querying involving multiple tables and subqueries.
• Demonstrated ability to conduct nuanced analyses to produce accurate and unbiased results and tell the story of those results in data visualizations and reports.
• Deep experience with healthcare data sources such as claims, electronic health record, event notification, clinical, and patient reported data.
• Proficient in Excel, Word and Power Point software
• Advanced data manipulation and data mining skills, including experienced level in SQL programming, and R or Python.
• Knowledge of standard methods for measuring health care utilization, spending, quality, and outcomes; risk adjustment; provider profiling; and related analytical tasks.
• Examine, interpret and report results of analytical initiatives to stakeholders.
• Excellent oral and written communication skills; ability to present complex information in an understandable and compelling manner
• Ability to work independently and in team environment
• Proven ability to work in a fast-paced environment where client satisfaction is key
• Preferred Qualifications:
  • Master's Degree or higher in Mathematics, Statistics, Actuarial Science or closely related field.
  • Experience with VRDC (CMS 100% Research Identifiable Files RIF) and/or LDS (5% Sample Data)
  • Prior experience in value-based care settings.
  • Expertise in descriptive and predictive analysis methods. Experience with regression and classification techniques.
  • Experience with causal analysis including designing and conducting experimental and quasi-experimental studies (e.g., randomized trials; regression discontinuity, difference-in-differences, instrumental variables, and matched designs).

The base salary hiring range for this position is $118,000 to $189,700. Compensation offered will be determined by factors such as location, level, job-related knowledge, skills, and experience. Certain roles may be eligible for incentive compensation, equity, and benefits.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. Eligible employees may enroll in a full range of medical, dental, and vision benefits, 401(k) retirement savings plan, and an Employee Stock Purchase Plan. We also offer education assistance, free development courses, paid time off programs, paid holidays, a CVS store discount, and discount programs with participating partners.