Manager, Actuarial Services – Tools & Models

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Candidates must be legally authorized to work in the United States without employer sponsorship, now or in the future.

The Actuarial Manager, Tools and Models will own the core actuarial models and tools used for reserving and forecasting claims across agilon's Medicare Advantage (MA) and value-based care populations. The Manager will help support the development of actuarial analysts through direct management and project leadership. The Manager will actively monitor and assess data quality, drive enhancements to Medical Margin Models, and enhance standardized reporting tools for close results at the market and national levels.

The Manager will play a central role in the annual budget process, including trend studies and the use of payor bid data to quantify year-over-year benefit changes and recommend trend adjustments for benefit relativity. As CMS transitions the ACO REACH program to ACO LEAD, the Manager will help design and build the actuarial models supporting the new program.

This is a fully remote position, with minimal required travel. This role reports to the Sr. Director for the Central Actuarial team. The Central team develops and maintains models, tools, and methodology that underpin the monthly close process that is carried out by the Markets team. The role is critical to the operations of the Actuarial team, and the Manager will be a key leader within the Actuarial and broader Data Solutions organization.

Essential Job Functions:

• Develop and maintain actuarial models and tools
• Actively monitor and assess data quality
• Drive enhancements to Medical Margin Models, including IBNR and revenue accrual methodology
• Evaluate and set claims completion factors quarterly for national payors
• Develop and maintain standardized reporting tools for close results utilizing statements data and/or payor data feeds
• Support development of the annual budget, including trend studies and key claims assumptions
• Leverage payor bid data to quantify year-over-year benefit design changes and recommend claims trend adjustments for benefit relativity
• Support the design and build-out of actuarial models for the ACO LEAD program as CMS guidance emerges
• Collaborate with Markets Actuarial teams to identify changes in national claims trends and drivers of prior period development
• Co-lead project intake, prioritization, and progress tracking across the Markets Actuarial and Central Actuarial teams
• Manage / mentor junior actuarial analysts
• Review and update internal / external audit documentation
• Support build-out of improved actuarial team processes

Other Job Functions:

• Develop talent through coaching, mentorship, and technical review
• Collaborate with Market Finance, FP&A, Accounting, Med Econ, and others
• Identify critical issues and recommend solutions to business problems
• Contribute to team priority-setting aligned with goals established by upper management
• Exemplify the core values of agilon health

Required Qualifications:

• Minimum Experience
  • 6+ years of actuarial experience (8+ years preferred)
  • Demonstrated leadership via project ownership and cross-functional initiatives, mentoring analysts, serving as a trusted delegate for a senior leader, and/or prior people management
• Education/Licensure
  • ASA or FSA designation
  • Bachelor's degree

Knowledge, Skills, and Abilities:

• Strong model building mindset; model flow, ease of use, auditability, etc.
• Experience with reserving, forecasting, and trend development
• Excellent ability to communicate actuarial methodology, both written and verbal
• Strong understanding of Medicare Advantage; ACO REACH or MSSP background is a plus
• Understanding of MA health plan data (Claims, MMR, MAO-004, etc.)
• Proficiency with Excel and SQL
• Experience presenting actuarial/financial concepts to a non-technical audience
• Proven problem-solving skills (identification of issue, causes, solution, implementation plan)
• Proven ability to influence, grow, and motivate others
• Entrepreneurial and innovative spirit

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Salary range shown is a guideline. Individual compensation packages can vary based on factors unique to each candidate, such as skill set, experience, and qualifications.

Originally posted on Himalayas