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 process

• Guide 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 strategy

• Consolidate results into clear summaries and lead the monthly results presentation to the Regional CFOs on the Market Finance team

Payer Settlement Reconciliation

• Review payer contract terms to establish how final settlements should be calculated

• Reconcile 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 targets

• Represent the finance organization directly with payer counterparts in a polished and professional manner to raise questions and request the detail needed for our review

Medicare Advantage Month-End Close Support

• Build and maintain supplemental close exhibits, such as schedules of revenue accrual assumptions and accrual amounts by payor and market

• Transform the actuarial team outputs into the required inputs for the FP&A team

• Quantify and present drivers of claims prior period development, separating natural month-over-month runout from methodology updates and other one-time considerations

Special Projects and Analyst Coaching

• Lead project intake, prioritization, and progress tracking across the actuarial team

• Lead high-priority ad hoc analyses end-to-end, flexing across markets and topics based on team needs

• Coach and mentor analysts through project work, providing technical direction and review to expand team capacity and enhance the quality of the work product

• Represent actuarial leadership in cross-functional forums and working groups, carrying decisions back to the actuarial team and ensuring completion of takeaway deliverables

Process Innovation

• Act 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 them

• Apply AI tools to claims analysis, automation of financial reporting, enablement of strategic decision-making, and review of payor contracts and financial statements

• Support build-out of improved actuarial team processes

Other Job Functions:

• Develop talent through coaching, mentorship, and technical review

• Collaborate with Market Finance, FP&A, Accounting, Medical Economics, Payer Contracting, and Regional Presidents

• Identify critical issues and recommend solutions to business problems

• Exemplify the core values of agilon health

Required Qualifications:

Minimum Experience

• 6+ 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 management

Education/Licensure

• ASA or FSA designation

• Bachelor's degree

Knowledge, Skills, and Abilities:

• Excellent ability to communicate and present a financial narrative, both written and verbal

• Strong understanding of Medicare Advantage and Value-Based Care concepts; experience with other CMS value-based arrangements (ACO REACH or MSSP) is a plus

• Understanding of MA health plan data (Claims, MMR, MAO-004, etc.)

• Ability to read and interpret payer contracts and translate terms into settlement expectations

• Experience with reserving and/or forecasting, and ability to lead work in these competencies

• Skilled in interpreting and manipulating large datasets, especially medical claims

• Proficiency with Excel and SQL; experience applying AI tools to actuarial work is a plus

• Comfortable operating as a player-coach: delivering hands-on analysis while guiding others

• Advanced problem-solving skills (identification of issue, causes, solution, implementation plan)

• Proven ability to influence, grow, and motivate others

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Location: ​

Remote - MD

Pay Range: ​

$129,700.00 - $162,100.00

Salary 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