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Actuarial Analyst V Risk Adjustment

Kaiser Permanente

Oakland, CA

Full-Time

Actuarial Analyst V Risk Adjustment

Kaiser Permanente

Oakland, CA

Full-Time

Mar 01, 2025

Accounting

Job Description

Job Summary:

This role will focus on advancing actuarial insights that improve risk adjustment performance across Medicare Advantage and ACA populations. Key areas of emphasis include HCC model analytics, forecasting of RAF scores, and the development of predictive models using clinical and claims data. The analyst will play a key role in shaping data-driven strategies to support accurate documentation, optimize financial outcomes, and inform enterprise decision-making. This is a highly collaborative and technical role that blends deep actuarial thinking with practical applications in government programs population health and revenue optimization.

Essential Responsibilities:

Practices self-leadership and promotes learning in others by building relationships with cross-functional stakeholders; communicating information and providing advice to drive projects forward; influencing team members within assigned unit; listening and responding to, seeking, and addressing performance feedback; adapting to competing demands and new responsibilities; providing feedback to others, including upward feedback to leadership and mentoring junior team members; creating and executing plans to capitalize on strengths and develop weaknesses; and adapting to and learning from change, difficulties, and feedback.

Conducts or oversees business-specific projects by applying deep expertise in subject area; promoting adherence to all procedures and policies; developing work plans to meet business priorities and deadlines; determining and carrying out processes and methodologies; coordinating and delegating resources to accomplish organizational goals; partnering internally and externally to make effective business decisions; solving complex problems; escalating issues or risks as appropriate; monitoring progress and results; recognizing and capitalizing on improvement opportunities; and evaluating recommendations made by others.

Completes actuarial documentation by reviewing and coordinating the actuarial portion of financial reports and tax returns, and responses to insurance regulations; and presenting results internally to mid-level leadership.

Develops and designs product line evaluations by interpreting and communicating findings of analysis of product line financials, reserve, valuation , cash flow analysis; and interpreting product line performance, risk, and assumptions used in product development.

Designs and develops actuarial research by designing complex methods to advance standards, assumptions, and the legal and regulatory environment.

Assesses, analyzes and interprets financial risks and opportunities by using non-traditional actuarial methods and actuarial judgment when conducting actuarial analyses.

Leads collaboration with business partners by translating complex actuarial constructs into actionable recommendations; and developing and formulating accurate actuarial and financial advice in compliance with the Actuarial Standards of Practice.

Creates framework and assumptions for new, existing, and non-traditional actuarial models to meet business needs.

Minimum Qualifications:

Bachelors degree in mathematics or related field AND Minimum eight (8) years actuarial experience. Additional equivalent work experience in a directly related field may be substituted for the degree requirement.

Associate of the Casualty Actuarial Society Certificate OR Associate of the Society of Actuaries Certificate

Additional Requirements:
Preferred Qualifications:

Experience with Medicare Advantage, Risk Adjustment Part C and Part D HCC modeling and analytics, and predictive modeling using clinical data sets.
Experience with Affordable Care Act, ACA Risk Adjustment modeling, forecasting.

Job Summary:

Essential Responsibilities:

Practices self-leadership and promotes learning in others by building relationships with cross-functional stakeholders; communicating information and providing advice to drive projects forward; influencing team members within assigned unit; listening and responding to, seeking, and addressing performance feedback; adapting to competing demands and new responsibilities; providing feedback to others, including upward feedback to leadership and mentoring junior team members; creating and executing plans to capitalize on strengths and develop weaknesses; and adapting to and learning from change, difficulties, and feedback.

Conducts or oversees business-specific projects by applying deep expertise in subject area; promoting adherence to all procedures and policies; developing work plans to meet business priorities and deadlines; determining and carrying out processes and methodologies; coordinating and delegating resources to accomplish organizational goals; partnering internally and externally to make effective business decisions; solving complex problems; escalating issues or risks as appropriate; monitoring progress and results; recognizing and capitalizing on improvement opportunities; and evaluating recommendations made by others.

Completes actuarial documentation by reviewing and coordinating the actuarial portion of financial reports and tax returns, and responses to insurance regulations; and presenting results internally to mid-level leadership.

Develops and designs product line evaluations by interpreting and communicating findings of analysis of product line financials, reserve, valuation , cash flow analysis; and interpreting product line performance, risk, and assumptions used in product development.

Designs and develops actuarial research by designing complex methods to advance standards, assumptions, and the legal and regulatory environment.

Assesses, analyzes and interprets financial risks and opportunities by using non-traditional actuarial methods and actuarial judgment when conducting actuarial analyses.

Leads collaboration with business partners by translating complex actuarial constructs into actionable recommendations; and developing and formulating accurate actuarial and financial advice in compliance with the Actuarial Standards of Practice.

Creates framework and assumptions for new, existing, and non-traditional actuarial models to meet business needs.

Minimum Qualifications:

Bachelors degree in mathematics or related field AND Minimum eight (8) years actuarial experience. Additional equivalent work experience in a directly related field may be substituted for the degree requirement.

Associate of the Casualty Actuarial Society Certificate OR Associate of the Society of Actuaries Certificate

Additional Requirements:
Preferred Qualifications:

Experience with Medicare Advantage, Risk Adjustment Part C and Part D HCC modeling and analytics, and predictive modeling using clinical data sets.
Experience with Affordable Care Act, ACA Risk Adjustment modeling, forecasting.

About Kaiser Permanente

At Kaiser Permanente, we’re all focused on helping people and providing high-quality, affordable health care services and to improve the health of our members and the communities we serve. Across our organization, we’re fiercely committed to our members, our mission, our communities, and each other. We know that each part of the Kaiser Permanente team is essential to our success. Together, we are more than 235,000 dedicated professionals working to advance Kaiser Permanente’s commitment to delivering a healthier tomorrow.

Driven by our collective passion at Kaiser Permanente, we strive to make health care more innovative and compassionate. With the wellness of our patients and our communities at heart, we work to revolutionize health and care from more than 650 locations in 8 states and D.C.

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Actuarial Analyst V Risk Adjustment

Kaiser Permanente

Oakland, CA

Mar 1, 2025

Full-time

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