Actuary (Healthcare Ecosystem)

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.