- CareSource (Dayton, OH)
- …developing and using pricing models related to Medicare Advantage Experience with Medicare Risk Adjustment Experience with building large Excel models ... Job Summary: The Actuarial Analyst II ( Medicare ) is responsible...reserves Evaluates government reimbursement process to determine areas of risk and opportunity Participates in initiatives to improve operating… more
- UnitedHealth Group (Cypress, CA)
- …and information acquisition tools Experience with provider capitation, both diagnostic risk - adjustment and age/sex adjusted rate banding Experience in ... validates Provider Network (physicians, hospitals, pharmacies, ancillary facilities, shared/full risk delegation, etc.) contracting and unit cost management activities… more
- Elevance Health (West Des Moines, IA)
- ** Risk Adjustment Actuarial Analyst II -...complex actuarial studies related to risk adjustment analytics in both the Medicaid and Medicare ... an accommodation is granted as required by law._ The ** Risk Adjustment Actuarial Analyst II...develops SAS and SQL programming to support Medicaid and Medicare Advantage risk adjustment initiatives.… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Senior Medicare Encounters Risk Adjustment Analyst assumes a pro-active approach in ensuring the accuracy and ... the impact of any changes to the HCC model and supporting actuarial in the calculation risk adjustment revenue. + Assists in designing an overall suite… more
- Amazon (New York, NY)
- …economics reporting and ad-hoc analysis relating to cost of care management - Medicare Risk score projections and premium estimation -Design and implement ... -Value based care contracting support and ongoing financial and risk analysis. -Support ongoing actuarial support for...(ASA) is required -Experience with Medicare or Medicare Advantage products -Strong knowledge of actuarial … more
- Excellus BlueCross BlueShield (Rochester, NY)
- …and external to ensure accuracy. Leads preparation reporting, valuation, and forecasting of risk adjustment scores and revenue to support partners internal and ... you to apply! Job Description: Summary: The Manager of Actuarial Services is responsible for managing a team that...+ Leads preparation of accruals/liabilities for CMS Part D risk sharing and Part C revenue settlements. + Leads… more
- Fallon Health (Worcester, MA)
- …of actuarial components of financial reports, regulatory submissions, and risk adjustment analyses + Collaborate with cross-functional teams including ... **Primary Job Responsibilities** + Assist in the development and maintenance of actuarial models for valuation, forecasting, pricing, and/or risk analysis +… more
- Point32Health (Canton, MA)
- …will oversee all provider engagement and reporting activities for risk adjustment programs and initiatives that impact Medicare , Medicaid, and Duals product ... Point32Health (https://www.point32health.org/) . **Job Summary** This position will lead the Risk Adjustment Operations & Provider Consulting team responsible… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …vendor performance relative to established contracts. * Collaborate with actuarial , finance, Medicare and risk adjustment to ensure all inputs and ... Medicare Provider Relations team! You will apply broad actuarial principles and modeling technical skills to develop solutions...with actuarial , finance, data & analytics, stars, risk adjustment , and other lever owners to… more
- Point32Health (NH)
- …in a matrix environment collaborating with functions including risk adjustment , population health, finance, operations, actuarial , and sales. **Job ... and products. The Director will lead a team who negotiates contracts including risk arrangements to enable high performing provider networks that support goals for… more
- Point32Health (Canton, MA)
- …key performance indicators for key initiatives + Serve as the key liaison for Actuarial , Finance, Risk Adjustment , Corporate Data and Analytics, Medical Cost ... functional teams (operations, clinical services, network management, finance, and actuarial , etc.) to ensure appropriate product management and successful… more
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