Senior Director, Actuary

At Habitat Health, we envision a world where older adults experience an independent and joyful aging journey in the comfort of their homes, enabled by access to comprehensive health care. Habitat Health provides personalized, coordinated clinical and social care as well as health plan coverage through the Program of All-Inclusive Care for the Elderly (“PACE”) in collaboration with our leading healthcare partners, including Kaiser Permanente. 

Habitat Health offers a fully integrated experience that brings more good days and a sense of belonging to participants and their caregivers. We build engaged, fulfilled care teams to deliver personalized care in our centers and in the home. And we support our partners with scalable solutions to meet the health care needs and costs of aging populations. 
 
Habitat Health is growing, and we’re looking for new team members who wish to join our mission of redefining aging in place. To learn more, visit https://www.habitathealth.com. 

Role Scope: 

We are looking for Senior Director, Actuary to serve as a critical analytics partner to the business, developing and maintaining advanced forecast models for risk adjustment, Incurred But Not Reported (IBNR) reserving, and medical claims planning. This role will collaborate with finance, clinical, and operational teams to deliver actionable insights that drive strategic decision-making, optimize financial performance, and ensure compliance with regulatory authorities. Responsibilities for the role will include: 

• Risk Adjustment Processes:
  • Develop and refine predictive models for risk adjustment scores, leveraging demographic, clinical, and claims data to ensure revenue accuracy per CMS guidelines.
  • Support annual and quarterly forecasting processes for risk adjustment projections and monthly accruals with Population Health, Health Plan, and Finance teams.
  • Analyze results to provide variance explanations and recommend adjustments to improve forecast accuracy.
• IBNR Processes:
  • Design and implement actuarial models to estimate IBNR liabilities, ensuring reserves are accurate and in compliance with all relevant regulatory standards.
  • Continually monitor and validate IBNR reserves, providing insights into monthly trends and proactively recommending necessary adjustments to Finance leadership.
• Strategic Analytics & Forecasting:
  • Analyze medical claims data to identify key cost drivers, utilization patterns, and operational trends, developing predictive models to forecast claims expenses.
  • Partner with clinical and operational teams to surface insights that inform care optimization strategies.
  • Utilize public and proprietary data sources to create medical claims forecasts for new markets and to inform planning in existing markets.