Senior Actuarial Analyst

As a Senior Actuarial Analyst, you will:

• Maintain internal CMS HCC and RxHCC models for calculating member level risk scores.
• Support the monthly close process, including the development of actuarial risk adjusted revenue accruals and analysis of results.
• Build reports to track ROI on various risk adjustment initiatives.
• Support actuarial teams in the development of risk scores for forecast and bidding purposes.
• Provide actuarial support on a wide variety of topics including risk adjustment, pricing, forecasting, reserving, trend analysis, and value-based care.
• Communicate analysis, findings, and supporting data meaningfully to leadership and partnering teams.
• Build automated actuarial tools and data pipelines.
• Support compliance under Sarbanes Oxley, including through process and tool design, peer review and control testing.
• Be accountable for key work products under the supervision of experienced actuaries.
• Collaborate with internal departments, including but not limited to, Data Science, Finance, Actuarial, Operations, Provider Network Management, Engineering, and external vendors on risk adjustment activities.
• Be eligible to participate in Clover's Actuarial Student Program.

Success in this role looks like:

• Within the first 90 days: You will learn Clover’s CMS HCC/RxHCC models and accurately support monthly close and revenue accrual processes, deliver clear and reliable analyses using claims and EDS data, and identify opportunities to improve or automate actuarial workflows.
• Within the first 6 months: You will independently own components of risk score modeling, forecasting, and monthly close processes, build automated tools or dashboards that improve efficiency and insight, and provide actionable analysis to support bidding and risk adjustment strategy.
• Future success: You will drive accurate revenue projections, serve as a trusted Medicare Risk Adjustment partner, continuously enhance automation and financial controls, and contribute strategic insights that support value-based care and long-term growth.

You should get in touch if:

• You have at least one year experience in health insurance; Medicare experience is preferred.
• You have completed at least two actuarial exams.
• You have an interest in building automated tools around actuarial analysis and experience building analytic dashboards.
• You are a self-starter, have a high degree of internal drive and motivation, and desire to execute at a high level.
• You have two years experience with Medicare Risk Adjustment, CMS EDS submissions, and healthcare claims data.