Actuarial Manager, Medicare Value-Based Care

Company:AHI agilon health, inc. Job Posting Location:Remote - USA Job Title: ​Actuarial Manager, Medicare Value-Based Care Job Description: ​Candidates must be legally authorized to work in the United States without employer sponsorship, now or in the future.agilon health partners with primary care physicians to transform how care is delivered to seniors, taking on full-risk, total-cost-of-care arrangements. The actuarial team's work sits at the center of that model.The Actuarial Manager, Medicare Value-Based Care is a senior individual contributor on the Markets actuarial team who will own the monthly results process for agilon's ACO REACH/ACO LEAD and MSSP populations, support payer settlement reconciliations, and produce supplemental exhibits for the month-end close. Operating in a consulting-style capacity, the Manager will also deliver high-priority analyses and project work, both individually and leading analysts from across the team, without direct people-management responsibility.This role is ideal for an experienced actuary who enjoys variety: roughly 40% of time is dedicated to CMS value-based program results, 40% to ad hoc projects and analyst coaching, and the remaining 20% to annual payer financial settlement work and select MA close deliverables. The Manager will also help incorporate AI support into the team's processes and co-lead project management across the actuarial organization.This is a fully remote position with minimal required travel. This newly established role reports to the Sr. Director for the Markets Actuarial team. The Markets team collaborates extensively with counterparts throughout the company, while peers on the Central team develop models, tools, and methodology. The role carries strong visibility with senior leaders across the organization, and the breadth of ownership is designed to build toward future leadership opportunities on the actuarial team.Essential Job Functions:Value-Based Program Results (ACO REACH/LEAD and MSSP)Own the end-to-end monthly results process: coordinate membership and revenue data intake from partner teams, run the retrospective trend adjustment (RTA) model, and oversee claims reserving and projection processGuide the team through the CMS transition from ACO REACH to ACO LEAD: partner with the Central actuarial team (tools/methodology) on new requirements, and the VP of Direct Contracting on strategyConsolidate results into clear summaries and lead the monthly results presentation to the Regional CFOs on the Market Finance teamPayer Settlement ReconciliationReview payer contract terms to establish how final settlements should be calculatedReconcile payer settlement calculations against contract terms and underlying claims and revenue data; identify discrepancies and build the analytical case to challenge settlements that are not handled correctly, contributing to the team's annual savings targetsRepresent the finance organization directly with payer counterparts in a polished and professional manner to raise questions and request the detail needed for our reviewMedicare Advantage Month-End Close SupportBuild and maintain supplemental close exhibits, such as schedules of revenue accrual assumptions and accrual amounts by payor and marketTransform the actuarial team outputs into the required inputs for the FP&A teamQuantify and present drivers of claims prior period development, separating natural month-over-month runout from methodology updates and other one-time considerationsSpecial Projects and Analyst CoachingLead project intake, prioritization, and progress tracking across the actuarial teamLead high-priority ad hoc analyses end-to-end, flexing across markets and topics based on team needsCoach and mentor analysts through project work, providing technical direction and review to expand team capacity and enhance the quality of the work productRepresent actuarial leadership in cross-functional forums and working groups, carrying decisions back to the actuarial team and ensuring completion of takeaway deliverablesProcess InnovationAct as a thought leader on AI adoption within the actuarial organization — exemplifying thoughtful, practical use of new tools, sharing what works, and building the team's fluency and confidence in applying themApply AI tools to claims analysis, automation of financial reporting, enablement of strategic decision-making, and review of payor contracts and financial statementsSupport build-out of improved actuarial team processesOther Job Functions:Develop talent through coaching, mentorship, and technical reviewCollaborate with Market Finance, FP&A, Accounting, Medical Economics, Payer Contracting, and Regional PresidentsIdentify critical issues and recommend solutions to business problemsExemplify the core values of agilon health Required Qualifications:Minimum Experience6+ 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 managementEducation/LicensureASA or FSA designationBachelor's degreeKnowledge, Skills, and Abilities:Excellent ability to communicate and present a financial narrative, both written and verbalStrong understanding of Medicare Advantage and Value-Based Care concepts; experience with other CMS value-based arrangements (ACO REACH or MSSP) is a plusUnderstanding of MA health plan data (Claims, MMR, MAO-004, etc.)Ability to read and interpret payer contracts and translate terms into settlement expectationsExperience with reserving and/or forecasting, and ability to lead work in these competenciesSkilled in interpreting and manipulating large datasets, especially medical claimsProficiency with Excel and SQL; experience applying AI tools to actuarial work is a plusComfortable operating as a player-coach: delivering hands-on analysis while guiding othersAdvanced problem-solving skills (identification of issue, causes, solution, implementation plan)Proven ability to influence, grow, and motivate othersProtect yourself: agilon health will never send unsolicited job offers or request payments or financial information. Such communications are fraudulent. Learn how to spot them Location: ​Remote - MD Pay Range: ​$129,700.00 - $162,100.00Salary 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