Actuary (Healthcare Ecosystem)

Posted on April 28, 2025 (5 days ago)

Job description

Role Overview

We are seeking a seasoned Actuary with demonstrable experience in return-on-investment (ROI) modeling within a healthcare (provider and payor) environment. The ROI Actuary will partner closely with clinical, finance, and strategy teams to design, implement, and interpret ROI analyses for value-based programs, service-line investments, and population-health initiatives. This role combines deep actuarial expertise, health-economics acumen, and strong communication skills to drive data-informed decisions that optimize clinical impact, financial performance, and patient outcomes.

Key Responsibilities

ROI Modeling & Analysis
- Develop, maintain, and validate ROI models for new service lines, care management programs, digital health tools, and community-health initiatives.
- Quantify cost savings, revenue impacts, utilization trends, and risk adjustments under various scenarios (e.g., bundled payments, ACO, readmission-reduction programs).
Data Management & Reporting
- Extract, cleanse, and aggregate claims, clinical, and financial data from multiple sources (EHR, billing, population-health platforms).
- Produce dashboards, scorecards, and executive-level presentations summarizing ROI findings, sensitivity analyses, and break-even timelines.
Strategic Partnership
- Collaborate with care-delivery leaders, value-based contracting teams, and senior executives to define business cases and investment priorities.
- Act as the subject-matter expert in actuarial assumptions, discount rates, utilization projections, and cost-benefit frameworks.
Regulatory & Compliance Support
- Ensure ROI analyses comply with actuarial standards of practice (ASOPs) and relevant healthcare regulations (e.g., CMS, NCQA).

Required Qualifications

Credentials: Associate of the Society of Actuaries (ASA) or Associate of the Casualty Actuarial Society (ACAS); advancement toward Fellowship (FSA/FCAS) strongly preferred.
Experience:
- 5+ years in healthcare actuarial or health-economics consulting, preferably within a health system, insurer, or value-based care organization.
- Proven track record of building robust ROI and cost-benefit models for clinical programs or population health interventions.
Technical Skills:
- Advanced proficiency in Excel modeling (including VBA), plus one or more actuarial tools (SAS, R, Python).
- Strong SQL skills and experience with BI platforms for dashboarding and visualization.
Domain Knowledge:
- Deep understanding of U.S. healthcare payment models, including fee-for-service, bundled payments, shared-savings ACOs, and capitation. Understanding on the payor side knowledge.
- Familiarity with claims adjudication, risk adjustment methodologies, and utilization management.
Soft Skills:
- Exceptional analytical rigor and attention to detail.
- Strong verbal and written communication skills; able to translate complex actuarial concepts for non-technical stakeholders.
- Collaborative mindset and ability to drive cross-functional initiatives through influence and subject-matter expertise.