Advisory Consultant - Actuarial

Advisory Consultant - Actuarial, Medicare, Analytics

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

The GL28 Actuarial/Analytics professional will support the development, enhancement, and maintenance of actuarial models across Medicare, and Medicaid lines of business. This role requires solid technical expertise, deep analytical capability, and hands-on experience with Medicare actuarial modeling - whether through Medicare Advantage Bid development, Medicare reporting, or management of Medicare actuarial tools and data assets. The position involves close collaboration with cross-functional teams to deliver high-quality insights, models, and analytics that drive business decisions.

Primary Responsibilities:

• Lead or support Medicare Advantage Bid work, including cost projections, revenue modeling, trend analysis, and risk score impacts
• Develop, maintain, and enhance Medicare actuarial tools for pricing, forecasting, and rate analysis
• Perform Medicare reporting and analytics, including performance monitoring, MLR tracking, variance analysis, and CMS related submissions
• Interpret CMS regulations and annual updates to ensure modeling and bid compliance
• Build and maintain actuarial and financial forecast models across Medicare, Commercial, and Medicaid
• Analyze cost drivers, utilization patterns, and healthcare trends to support pricing, forecasting, and strategic decisions
• Execute large scale data extraction and analysis using SQL, SAS, R, Python, or similar tools, and automate reporting using Excel, VBA, Power BI, etc.
• Communicate complex findings to senior stakeholders and collaborate across actuarial, finance, product, and clinical teams
• Mentor junior analysts and contribute to model governance, documentation, and process improvements
• Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so

Required Qualifications:

• Bachelor’s degree in Mathematics, Statistics, Actuarial Science, Engineering, Data Science, or related technical field
• 7+ years of relevant experience in the financial or insurance domain
• 3+ years of experience in U.S. healthcare analytics, including claims, cost modeling, or pharmacy analytics
• Hands-on experience in at least one of the following: Medicare Bids, Medicare reporting, or Medicare actuarial tool development
• Solid proficiency with SAS, SQL, Python, Power BI, and preferably exposure to Databricks and/or Snowflake for large scale data processing and analytics
• Proven solid communication skills with experience presenting to senior stakeholders
• Proven ability to manage multiple workstreams concurrently in a fast-paced environment

Preferred Qualification:

• On the actuarial exam track with 7+ exams completed (IFoA, IAI, SOA)