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Medicare Risk Adjustment and Stars Actuary

Company: CAMBIA
Location: Seattle
Posted on: January 17, 2020

Job Description:


Medicare Risk Adjustment & Stars Actuary

(Actuary Associate I-III or Senior Actuary depending on experience)

Seattle, Portland or Remote

Cambia s Actuarial Division is responsible for proactively managing and retrospectively tracking and reporting on the financial and risk positions within the company and supporting the strategic goals of the corporation. Within that context, our actuary team performs and manages technical, analytical, support, and leadership functions to help the division and the company meet its goals.

The ideal candidate would have experience with Medicare Advantage Bid, Medicare risk adjustment, and Stars. Preferred candidate would have thorough knowledge of the end-to-end risk adjustment cycle, and its impact to revenue. Knowledge of the Medicare risk adjustment payment model, CMS Guidelines, Risk Adjustment Processing System (RAPS), and Encounter Data Submission (EDS)."

At Cambia, our values are fundamental to achieving our Cause of transforming the health care industry. They guide our actions and bring diverse perspectives together to improve the health care journey better for those we serve. All eight values are equally important and linked to the others: Empathy, Hope, Courage, Trust, Commitment, Innovation, Collaboration and Accountability. These values are not just words on paper - we live them every day.


* Member of the American Academy of Actuaries in good standing.

* Associate in the Society of Actuaries in good standing.

* Proven ability to perform and manage difficult actuarial tasks.

* Keen analytical and problem-solving skills.

* Demonstrated success with project management.

* Very well-developed business sense (finance, accounting, economics, risk management).

* In-depth working knowledge of how an insurance company functions.

* Solid oral and written communication skills.

* Strong computer skills (Excel, Word, Access and SAS.)

* Ability to work independently on complex projects and issues with large financial and/or risk impact to the corporation.


* Actuary Associate I: Bachelor s degree in mathematics, actuarial science, statistics, economics, computer science or an equivalent related field. Minimum 4 years experience and have completed at least 1 FSA exam and/or set of modules, or Career ASA, MAAA with a minimum of 6 years experience.

* Actuary Associate II: Bachelor s degree in mathematics, actuarial science, statistics, economics, computer science or an equivalent related field. Minimum 5 years experience and have completed at least 2 FSA exams and/or sets of modules, or Career ASA, MAAA with a minimum of 7 years experience.

* Actuary Associate III: Bachelor s degree in mathematics, actuarial science, statistics, economics, computer science or an equivalent related field. Minimum 6 years experience and close to achieving FSA or Career ASA, MAAA with a minimum of 8 years experience.

* Senior Actuary I: Bachelor s degree in mathematics, actuarial science, statistics, economics, computer science or an equivalent related field. Minimum 7 years experience or Career ASA, MAAA with a minimum of 10 years experience

General Functions & Outcomes:

* Responsible for corporate profitability by prudent management of risk.

* Provides actuarial support to any or all divisions of the organization.

* Performs actuarial certification duties for the corporation as required.

* Contributes to strategic and tactical planning efforts.

* Manages sustainment projects, delegating to junior team members.

* Completes all level of peer review, both technical and reasonableness.

* Recommends and supports assumptions to team management.

* Effectively responds to complex customer questions.

* Effectively recommends response to senior leadership for non-routine regulator questions.


At Cambia, we advocate for transforming the health care system. You aren t satisfied with the status quo and neither are we. We're looking for individuals who are as passionate as we are about transforming the way people experience health care. We offer a competitive salary and a generous benefits package. We are an equal opportunity employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A drug screen and background check is required.

Cambia s portfolio of companies spans health care information technology and software development; retail health care; health insurance plans that carry the Blue Cross and Blue Shield brands; pharmacy benefit management; life, disability, dental, vision and other lines of protection; alternative solutions to health care access; and free-standing health and wellness solutions.

We have over a century of experience in developing and providing health solutions to serve our members.

We had our beginnings in the logging communities of the Pacific Northwest as innovators in helping workers afford health care. That pioneering spirit has kept us at the forefront as we build new avenues to improve access to and quality of health care for the future.

Keywords: CAMBIA, Seattle , Medicare Risk Adjustment and Stars Actuary, Accounting, Auditing , Seattle, Washington

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