Senior Healthcare Actuarial Consultant

Job Location: 

This role is 100% remote.

Clearance:

Must be currently authorized to work in the United States on a full-time basis and have the ability to obtain a Public Trust Security Clearance. 

Job Description:

Blake Willson Group is seeking a Senior Healthcare Actuarial Consultant to support the evaluation of complex healthcare proposals for a major federal procurement. The consultant will apply hands-on experience with healthcare data, cost and utilization models, reimbursement, pricing, risk adjustment, and rate development to independently evaluate proposals and supporting analyses. Working with a Senior Pricing Consultant, the consultant will translate complex healthcare data and analytical findings into clear recommendations supporting proposal evaluation, clarifications, negotiations, and source selection. The ideal candidate will have recent hands-on healthcare modeling and data analysis experience and the ability to independently assess assumptions, methodologies, and supporting data. In this position, you will also:

• Evaluate healthcare proposal pricing, cost models, rate-development methodologies, utilization, reimbursement, trend, risk adjustment, and supporting data.
• Review solicitation requirements, evaluation criteria, data specifications, amendments, Government assumptions, and other acquisition documentation.
• Analyze claims, encounter, eligibility, membership, provider, utilization, reimbursement, and other healthcare data for quality, completeness, consistency, and reasonableness.
• Review, modify, maintain, test, and independently validate healthcare analytical and pricing models, including formulas, assumptions, inputs, outputs, and model logic.
• Evaluate healthcare cost projections and identify key drivers, anomalies, unsupported assumptions, methodological limitations, data deficiencies, and financial risks.
• Perform calculations, reconciliations, sensitivity analyses, scenario testing, benchmarking, and other analytical procedures to assess proposed results.
• Compare proposal assumptions and results against historical experience, Government assumptions, independent estimates, market data, and other relevant benchmarks.
• Develop clarification questions, written findings, and recommendations addressing data, modeling, methodology, pricing, and potential financial risks.
• Collaborate with the Senior Pricing Consultant and acquisition team to support proposal evaluations, negotiations, source selection, and analysis of proposal revisions and FPRs.
• Maintain traceable workpapers and communicate clear analytical findings to technical, financial, acquisition, and Government stakeholders while protecting sensitive information.

Required Skills:

• Bachelor’s degree in Actuarial Science, Mathematics, Statistics, Economics, Healthcare Analytics, or a related field.
• 7+ years of experience in healthcare actuarial analysis, managed-care analytics, healthcare economics, reimbursement, claims analytics, healthcare pricing, data analytics, or a related field.
• 3+ years of recent hands-on experience developing, maintaining, materially modifying, testing, or independently validating healthcare cost, utilization, reimbursement, pricing, or rate-development models, including direct analysis of underlying healthcare data and assumptions.

Desired Skills:

• Experience evaluating another organization's healthcare pricing, rates, actuarial submissions, reimbursement proposals, analytical models, or underlying assumptions for a purchaser, regulator, health plan, Government agency, or advisory client.
• Experience supporting federal or state healthcare procurements, proposal evaluations, price analysis, clarification development, negotiation support, source selection, or related acquisition activities.
• Experience with Medicare, Medicaid, TRICARE, VA Community Care, FEHB, commercial managed care, or other large-scale healthcare programs, including medical, dental, pharmacy, health-plan, TPA, or provider-network environments.
• Experience analyzing healthcare data, including claims, encounter, eligibility, membership, provider, reimbursement, and utilization data, and performing data validation, reconciliation, trend analysis, benchmarking, sensitivity analysis, or scenario modeling.
• Experience using SQL, SAS, R, Python, Power BI, Power Query, Excel, or other analytical, actuarial, modeling, or business intelligence tools, with the ability to develop clear analytical reports, proposal findings, price analyses, or negotiation-support materials.
• ASA or FSA designation, membership in the American Academy of Actuaries, active progress toward an actuarial credential, or substantial equivalent healthcare actuarial experience, with demonstrated ability to communicate complex analytical findings and deliver accurate, traceable products under compressed procurement timelines.

At Blake Willson Group, we believe in transparency and fairness in compensation practices. For this position, we offer a competitive salary range of $130,000 to $180,000 in the United States. Your individual salary within this range will be determined by various factors, including but not limited to your education, experience, skills, and geographic location. We also provide a comprehensive Total Rewards package, which includes major medical benefits such as dental and vision coverage, a 401(k)-contribution plan, holiday and personal time off, professional development training & certification benefits, health & wellness subsidies, paid time off for community service, and more. We value your contributions and are committed to recognizing and rewarding your performance and the value you bring to our business.