Job Description
Job DescriptionDescriptionAbout the Role
We are seeking an Actuarial Manager to serve as the primary owner of Astrana’s Medicare Advantage risk adjustment process. This role will have responsibility for validating data, accruing risk scores, and building a scalable, defensible risk adjustment process from the ground up. You will partner closely with our Data and Quality teams, you will be the individual ultimately accountable for interpreting results, translating them into financial accruals, and serving as the authoritative voice on risk adjustment for Finance and senior leadership. Over time, as the risk adjustment process matures, this role will have the opportunity to expand into actuarial forecasting and financial planning efforts more broadly across the business.
This role is an individual contributor role with accountability for process ownership and execution; it does not have direct people management responsibility at this time. This role will report to the Senior Manager, Actuary, and the position is open for remote work.
Our Values:
- Put Patients First
- Empower Entrepreneurial Provider and Care Teams
- Operate with Integrity & Excellence
- Be Innovative
- Work As One Team
What You'll DoPrimary Responsibility: Risk Adjustment Ownership
· Own end-to-end Medicare Advantage risk score accruals across Astrana’s $1B+ MA book of business
· Serve as the accountable owner of the risk adjustment process, including data validation, accrual methodology, and financial interpretation.
· Partner with Data to operate and refine Astrana’s internal HCC engine, while owning the validation, interpretation, and financial application of its outputs.
· Act as the internal risk adjustment subject matter expert, staying current on CMS model changes and regulatory guidance and contribute actuarial expertise into Astrana’s advocacy efforts in the space.
· Translate risk adjustment results into actionable insights for Quality, Finance, and Operations teams.
Secondary Responsibility: Forecasting & Financial Modeling
· Support budgeting and forecasting for Astrana’s $3B+ Care Partners segment.
· Build and maintain actuarial models that improve internal actuarial forecasting abilities and seamlessly integrate with FP&A’s models and processes.
· Integrate risk adjustment assumptions into actuarial forecasts and FP&A processes.
· Develop actual-to-expected tools and explain variances versus forecasted results.
Enablement & Cross-Functional Impact
· Build analytical infrastructure, including recurring reports and dashboards, to monitor risk adjustment performance.
· Present findings and recommendations to Finance leadership and business partners.
· Conduct ad hoc analyses related to benchmarking, contract optimization, and strategic initiatives.
What Success Looks Like:
· Within 6 months, risk adjustment accruals are accurate, repeatable, and clearly documented.
· Stakeholders across Finance, Quality, and Data trust this role as the source of truth for risk adjustment.
· Opportunities to improve process efficiency or financial accuracy are proactively identified and implemented.
Qualifications· FSA or ASA credentials or near attainment of ASA credentials.
· 5+ years of actuarial experience.
· 2+ years of Medicare Advantage experience, including hands-on experience with risk adjustment.
· Deep understanding of the MA HCC risk adjustment model and its financial application.
· Advanced knowledge of Microsoft Excel.
· Working knowledge of SQL or ability to self-serve analytical needs using modern data tools, including AI-assisted workflows.
· Comfort operating in ambiguity and building efficient processes from scratch.
Preferred Qualifications:
· Experience accruing risk scores.
· Pricing/forecasting experience.
· Experience with Medicare Advantage bid mechanics.
· Experience with Medicaid and/or Commercial risk adjustment models.
· Knowledge working with PowerBI.
· Experience in the California healthcare market.
Environmental Job Requirements and Working Conditions· This position has the option to be remotely based in the U.S. Conversely, candidates can choose to work in a hybrid fashion and work through the Alhambra, CA, Las Vegas, NV, or Houston, TX Astrana Health offices.
· The hiring manager for this role sits in the Eastern Time Zone, while many of the business partners work on Pacific Time.
· The total compensation target pay range for this role is: $135,000 – $165,000. The salary range represents our national target range for this role.
· Astrana Health offers a competitive Actuarial Student Program for any candidate seeking their ASA or FSA credentials.
Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based on race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided based on qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation. Additional Information:The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.