[Remote] Lead Actuarial & Risk Modeling Specialist – Data Science & AI (US Healthcare)

Note: The job is a remote job and is open to candidates in USA. Fractal Analytics is a strategic AI partner to Fortune 500 companies, aiming to power every human decision in the enterprise. They are seeking a highly experienced actuarial and risk modeling specialist to lead the design and development of models that drive predictive analytics and AI-enabled decision making in the US healthcare system.ResponsibilitiesDesign, build, and enhance actuarial models related to medical cost forecasting, utilization risk, trend analysis, and financial projectionDevelop risk adjustment, severity, and morbidity models for Medicare, Medicaid, and Commercial populationsLead modeling efforts for cost-of-care, member risk stratification, high-cost claimant prediction, and population health risk scoringApply proven actuarial methodologies while incorporating advanced statistical and machine learning techniques where appropriatePartner with Data Science and AI teams to translate actuarial models into scalable analytical and AI solutionsEvaluate and guide the use of ML approaches (GLMs, GAMs, gradient boosting, survival analysis, time series, etc.) alongside actuarial methodsEnsure explainability, stability, and regulatory readiness of risk models used in AI-driven workflowsSupport development of predictive and prescriptive analytics used in Payment Integrity, care management, utilization management, and financial risk mitigationPerform deep analysis across claims, member, and provider datasets to identify cost drivers, risk concentration, and leakageQuantify financial impact of payment programs, adjudication rules, benefit design, and provider behaviorSupport Payment Integrity (PI) use cases including duplicate claims, pricing anomalies, eligibility issues, and reimbursement accuracyPartner with finance and actuarial teams on budgeting, reserving, and forecasting exercisesAct as a domain authority for actuarial and healthcare risk concepts within data science and AI initiativesTranslate complex analytical results into clear, executive-ready insights and recommendationsGuide analysts and data scientists on actuarial standards, modeling assumptions, and validation techniquesSupport regulatory, audit, and compliance reviews through transparent documentation and defensible methodologiesSkills10+ years of experience developing actuarial, risk, or financial models in the US healthcare industryStrong background in one or more segments: Medicare (MA, FFS, Risk Adjustment), Medicaid / State programs, Commercial / Employer plansProven experience with cost modeling, utilization forecasting, trend analysis, and member risk stratificationDeep understanding of claims adjudication, benefit design, pricing, and reimbursement mechanicsAdvanced statistical modeling expertise (GLMs, regression, survival models, time series)Strong hands-on experience with analytical tools and languages (Python, R, SQL, or similar)Ability to work with large, complex healthcare datasets (claims, eligibility, provider, utilization)Experience collaborating with data science teams using modern analytics platforms (Databricks or similar preferred)Exceptional analytical thinking and problem-solving abilityStrong communication skills with the ability to explain complex actuarial concepts to technical and non-technical audiencesDemonstrated ability to influence decisions at senior leadership levelsActuarial credentials (ASA, FSA) or significant progress toward certificationExperience supporting AI, advanced analytics, or digital transformation initiativesExposure to Payment Integrity, FWA analytics, care management, or utilization management programsExperience with forecasting dashboards, scenario modeling, or executive financial reportingFamiliarity with Call Center datasets (member & provider interactions), Provider RCM data, and/or EHR/clinical data for integrated risk analysisCompany OverviewFractal is an AI firm with the aspiration to power every human decision in theenterprise. It was founded in 2000, and is headquartered in Mumbai, Maharashtra, IND, with a workforce of 5001-10000 employees. Its website is http://www.fractal.ai.