Job Details

Job Description:
A Medicare Part D Actuarial Consultant is needed to support risk adjustment and benefit modeling efforts due to recent personnel changes and internal capacity needs. The primary focus involves analyzing risk scores, forecasting and understanding downstream impacts of various changes within Part D. Key responsibilities include revising existing actuarial models, documenting processes for training and internal use, and developing recurring reports to monitor financial and risk metrics. The role aims to embed this expertise into the existing team with comprehensive documentation and training to ensure continuity and knowledge transfer.

Responsibilities:

• Review and revise the current Part D actuarial model to enhance robustness, transparency and predictive capabilities.

• Analyze risk adjustment factors such as RxHCCs and prevalence shifts to improve model accuracy.

• Estimate final risk scores and assess downstream impacts of coding changes and benefit transitions.

• Investigate PDE coding modifications and error reporting mechanisms to inform risk models.

• Model benefit-phase transitions including deductible, ICL and catastrophic phases.

• Evaluate TrOOP and TGCDC dynamics to refine risk forecasts.

• Assess and incorporate IRA redesign impact on Part D benefits and risk models.

• Implement recurring reporting such as monthly revenue variance, risk score trends, financial dashboards and IRA implementation trackers.

• Create comprehensive documentation, control narratives and operations manuals for Part D models.

• Prepare and train internal staff to ensure a smooth transition and ongoing operational readiness.

Requirements:

• 10+ years of actuarial experience with Medicare Part D payments, reconciliation, DIR, risk adjustment and PDE operations

• Deep working knowledge of PDE layouts, DIR reporting requirements, Part D settlement processes, IRA redesigns, CMS payment reports and monthly remittance

• Strong coding skills in SQL and SAS

• Experience with risk management and comprehensive actuarial documentation

• ASA or FSA designation (preferred), or equivalent Part D financial experience

Pay Range:
The anticipated pay range for this position is $80.00 to $85.00 per hour. We understand salary is an important factor in a job search, and we encourage you to apply even if you feel that your desired compensation may fall outside of the listed range. The final pay for this position is determined based on several factors including but not limited to, relevant experience, skills and certifications, education and training, geographic location, market conditions, and internal equity. We are committed to finding the right candidate for this role and are open to discussing how your unique qualifications align with our needs.

Benefits:

• Medical insurance

• Dental insurance

• Vision insurance

• 401(k) retirement savings plan

Contact:
Karrie Ruch
krush@jacobsongroup.com

Equal Opportunity Employer:
The Jacobson Group is committed to fostering an inclusive and equitable workplace that reflects the diverse communities we serve. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status or any other protected characteristic as defined by applicable law. We believe that diversity of thought, background and experience strengthens our team and drives innovation. All employment decisions are based on qualifications, merit and business needs.
If you require a reasonable accommodation to complete the application process or participate in an interview, please contact us at HR@jacobsongroup.com or +1 (800) 466-1578 to make a request.

Refer a Colleague:
Do you know someone who would be interested in this project? Submit your referral directly by emailing the Jacobson contact listed above or submitting them through this form. If your referral is hired for a contract assignment and meets all other eligibility criteria, you will receive a referral bonus!