Actuary

About the role

The actuary in this role owns the financial modeling and analytics that underpin Ennoble Care's value-based care strategy, directly influencing how the organization performs within CMS and CMMI total cost of care frameworks. You will own the design and execution of actuarial analyses that quantify risk, predict costs, and measure the financial impact of clinical and operational decisions across patient populations. This position owns the responsibility of transforming complex Medicare and value-based care rules into robust quantitative models that support strategic and operational planning. You will own the stewardship of key methodologies such as IBNR and risk score projections, ensuring they are grounded in high-quality data and sound actuarial principles. The role requires ownership of end-to-end analytical workflows, from data acquisition and integration to insight generation and stakeholder communication. You will own the development of predictive and prescriptive models that enable proactive management of financial performance and population health outcomes. Ultimately, this position owns the critical interface between actuarial rigor and business execution, providing the analytical foundation that guides leadership decisions in a rapidly evolving healthcare landscape.

Key facts

What you'll do

Analyze VBC performance under various CMS and CMMI total cost-of-care models to identify financial trends and risk exposures.

Monitor and forecast financial performance across assigned patient populations using actuarial and statistical techniques.

Conduct comprehensive claims analysis using CCLF and BCDA datasets to extract actionable insights on utilization and cost.

Refine key reporting and projection methodologies, including IBNR and Risk Score projections, to improve accuracy and reliability.

Process and analyze large healthcare datasets, combining multiple data sources including EHR systems and Medicare claims data.

Ensure data quality and integrity across all analytical processes through rigorous validation and governance practices.

Develop and maintain SQL-based data structures to support population experience studies and VBC program analytics.

Create fit-for-purpose analytical reports that translate complex actuarial findings into actionable business insights for decision-makers.

Develop executive dashboards and performance metrics aligned with organizational strategic goals to track financial and clinical outcomes.

Present findings and recommendations to leadership teams and clinical stakeholders to facilitate data-driven discussions.

Support budget planning and financial forecasting processes by providing scenario analysis and sensitivity testing.

Stay current with evolving CMS and CMMI program requirements and quality measures to ensure models remain compliant and relevant.

Champion continuous improvement initiatives by identifying opportunities to enhance analytical methods, tools, and workflows.

Collaborate with cross-functional teams to integrate actuarial insights into broader care delivery and operational strategies.

Requirements

Bachelor's degree in Actuarial Science, Statistics, Mathematics, Data Science, or related quantitative field is required for eligibility.

ASA credentials are preferred for Actuarial candidates and must be pursued or partially completed as a condition of the role.

Candidates must possess strong healthcare data analytics experience in Medicare-focused or Medicare Advantage environments, with a minimum of 5 years of relevant experience.

A thorough understanding of and hands-on experience with Medicare risk adjustment and CMS-HCC models is mandatory for this position.

Experience working with CMS and CMMI total cost of care programs, including ACOs and value-based arrangements, is required.

A proven track record of spearheading claims analytics using Medicare claims data is essential for success in this role.

In-depth knowledge of healthcare billing processes from both provider and CMS perspectives is necessary to ensure accurate analysis and interpretation.

Advanced proficiency in Microsoft Excel and model building is required to handle complex actuarial calculations and scenario analysis.

Strong SQL skills with the ability to write complex queries are required to manage and extract data from large healthcare databases.

Experience with the Microsoft Azure cloud platform and related analytics tools is preferred to support scalable data processing and model deployment.

Experience with integrating data across multiple large, nuanced data sources, such as EHR data with claims datasets, is required.

Experience developing or integrating AI-forward workflows into analytics is preferred to keep pace with innovation in healthcare modeling.

Exceptional analytical and problem-solving capabilities are required to navigate complex datasets and derive meaningful insights.

Strong business acumen is necessary to translate technical findings into strategic recommendations that align with organizational objectives.

Excellent written and verbal communication skills are required for both technical and non-technical audiences to ensure clarity and impact.

A proven ability to work effectively as a team player in cross-functional projects is essential for collaboration and success.

Demonstrated capability to understand and respond to evolving business needs is required to maintain relevance and agility in a dynamic environment.

Nice to have

Experience with Ennoble Care's specific technology stack and data infrastructure would be advantageous but is not required.

Familiarity with prior roles in home-based or community-centered care models is preferred.

An understanding of remote patient monitoring and behavioral health management integration is preferred.

Practical notes

This is a full-time position based in the United States.

Employees are eligible for comprehensive benefits, including medical, dental, vision, life insurance, and disability coverage.

Additional benefits include paid time off, paid office holidays, 401(k) with company match, and a pay-on-demand program.

Candidates must disclose any current or future need for employment-based immigration sponsorship, including OPT, STEM OPT, or visa sponsorship, before an offer is extended.

Ennoble Care is an Equal Opportunity Employer committed to diversity and inclusion.