Avanciers is a premier IT Staffing/Consulting organization and we are currently recruiting for a contract role for one of our premier client in USA for Actuarial & Advanced Risk Analytics.
Job ID: AV27236
Role: Lead Actuarial & Risk Modeling Specialist - Data Science & AI (US Healthcare)
Location: Fully Remote
Duration: 6+ months
Job Description Below:
Actuarial and Healthcare Risk Analytics Expertise – Essential Requirement
Primary Responsibilities:
Actuarial Modeling and Risk Assessment
- Develop, maintain, and refine actuarial models to support medical cost projections, utilization forecasting, trend evaluation, and long-term financial planning.
- Create and enhance risk adjustment, morbidity, and severity models for Medicare, Medicaid, and Commercial healthcare populations.
- Apply actuarial methodologies to evaluate financial risk and support strategic decision-making across healthcare programs.
Advanced Healthcare Analytics and AI Integration
- Collaborate with Data Science and AI teams to operationalize actuarial models into scalable analytical frameworks and intelligent solutions.
- Provide guidance on the application of statistical and machine learning techniques—including Generalized Linear Models (GLMs), Generalized Additive Models (GAMs), gradient boosting, survival modeling, and time-series forecasting—in conjunction with traditional actuarial approaches.
- Contribute to the design and implementation of predictive and prescriptive analytics that improve payment integrity, care management, utilization oversight, and risk reduction initiatives.
Claims Analytics and Financial Performance Evaluation
- Conduct comprehensive analyses of claims, member, provider, and utilization data to uncover cost drivers, identify risk concentrations, and detect revenue leakage opportunities.
- Assess the financial implications of reimbursement programs, claims adjudication policies, benefit structures, and provider practice patterns.
- Support Payment Integrity initiatives by identifying issues such as duplicate billing, pricing discrepancies, eligibility concerns, and reimbursement inaccuracies.
- Work closely with finance and actuarial stakeholders to support budgeting, reserve analysis, forecasting, and financial planning activities.
Leadership, Communication, and Stakeholder Engagement
- Serve as a subject matter expert on actuarial principles and healthcare risk management within analytics, data science, and AI-driven programs.
- Present complex analytical findings in a concise, business-focused manner suitable for executive audiences and key stakeholders.
- Mentor analysts and data scientists by providing direction on modeling best practices, actuarial assumptions, validation methodologies, and interpretation of results.
- Ensure regulatory compliance and audit readiness through clear documentation, transparent processes, and well-supported analytical methodologies.
Qualifications and Experience
Actuarial and Healthcare Risk Management
- Minimum of 9 years of experience designing and implementing actuarial, risk, or financial models within the U.S. healthcare sector.
- Demonstrated expertise in one or more of the following healthcare markets:
- Medicare (including Medicare Advantage, Fee-for-Service, and Risk Adjustment programs)
- Medicaid and state-sponsored healthcare programs
- Commercial and employer-sponsored health plans
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