Actuary - Value-Based Care

About the role

Ennoble Care is a mobile primary care, palliative care, and hospice service provider with patients in New York, New Jersey, Maryland, DC, Virginia, Oklahoma, Kansas, Pennsylvania, Texas, Florida, and Georgia. Ennoble Care's clinicians go to the home of the patient, providing continuum of care for those with chronic conditions and limited mobility. Ennoble Care offers a variety of programs including, remote patient monitoring, behavioral health management, and chronic care management, to ensure that our patients receive the highest quality of care by a team they know and trust. We seek individuals who are driven to make a difference and embody our motto, "To Care is an Honor." Join Ennoble Care today! Position Overview We are seeking an experienced Actuary (5+ years of experience) for our value-based care (VBC) team. This role requires a seasoned professional in medical economics, actuarial, or equivalent data analytics experience who can navigate the complex landscape of Medicare risk models, value-based care arrangements, and population health analytics. The ideal candidate will play a critical role in optimizing our organization's performance under CMS total cost of care models while ensuring sustainable financial outcomes. Candidates will ideally have their ASA certification or have passed at least the first three exams. This role is currently scoped as an individual contributor, with a growth trajectory toward leadership over time.

Responsibilities

• Data Management & Medicare Analytics
• Analyze VBC performance under various CMS and CMMI total cost-of-care models.
• Monitor and forecast financial performance across assigned patient populations.
• Conduct comprehensive claims analysis using CCLF (Claims and Claims Line Feed) and BCDA (Beneficiary Claims Data API) datasets.
• Refine key reporting and projection methodologies, including IBNR and Risk Score projections.
• Process and analyze large healthcare datasets, combining multiple data sources including EHR systems and Medicare claims data.
• Ensure data quality and integrity across all analytical processes.
• Develop and maintain SQL-based data structures to support population experience studies and VBC program analytics.
• Business Intelligence & Reporting
• Create fit-for-purpose analytical reports that translate complex actuarial findings into actionable business insights.
• Develop executive dashboards and performance metrics aligned with organizational strategic goals.
• Present findings and recommendations to leadership teams and clinical stakeholders.
• Support budget planning and financial forecasting processes.
• Regulatory Compliance & Process Improvement
• Stay current with evolving CMS and CMMI program requirements and quality measures.
• Required Qualifications
• Education & Certification
• Bachelor's degree in Actuarial Science, Statistics, Mathematics, Data Science, or related quantitative field
• ASA credentials preferred for Actuarial candidates
• Experience Requirements
• Strong healthcare data analytics experience in Medicare-focused or Medicare Advantage environments (5+ years of experience)
• Thorough understanding of and hands-on experience with Medicare risk adjustment and CMS-HCC models
• Experience working with CMS and CMMI total cost of care (ACO) programs
• Proven track record spearheading claims analytics using Medicare claims data
• In-depth knowledge of healthcare billing processes from both provider and CMS perspectives
• Technical Proficiency
• Advanced proficiency in Microsoft Excel and model building
• Strong SQL skills with the ability to write complex queries
• Experience with the Microsoft Azure cloud platform and related analytics tools preferred
• Experience with integrating data across multiple large, nuanced data sources (e.g., integration of EHR data with claims datasets)
• Experience developing/integrating AI-forward workflows into analytics
• Core Competencies
• Exceptional analytical and problem-solving capabilities
• Strong business acumen with the ability to translate technical findings into strategic recommendations
• Excellent written and verbal communication skills for both technical and non-technical audiences
• Proven team player with a collaborative approach to cross-functional projects
• Demonstrated capability to understand and respond to evolving business needs

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