Actuary - SHP

Organization:

Sutter Health Plan - Valley

Position Overview: 

Supports financial model design, including reserving, rate analysis, and actuarial data mart development. Provides guidance on a range of topics such as risk adjustment, utilization, product pricing including benefit design, contracting, premium revenue, and trend forecasting. Participates as a key financial expert on the ACA risk adjustment program. Partners with Information Services (IS) and purchase actuarial data products to ensure data integrity and integration of the Health Rules Platform and the Data Warehouse for a scalable, configurable and verifiable data pipeline for healthcare analytics. This position requires an ASA. Candidates with all exam requirements will be considered if an ASA is expected within 6 months of hire.

The candidate must live in California or be willing to relocate.

Job Description:

EDUCATION:
Equivalent experience will be accepted in lieu of the required degree or diploma.

• Bachelor's: Actuarial Science, Economics, Mathematics or related field. or equivalent education/experience

TYPICAL EXPERIENCE:

• 8 years recent relevant experience

SKILLS AND KNOWLEDGE:

• Expertise in actuarial pricing, underwriting, statistical modeling, analytics, networks, forecasting and reserve systems, including expert knowledge of the applicable
• Actuarial Standards of Practice (ASoP) issued by Actuarial Standards Board (ASB), generally accepted accounting principles (GAAP) and internal/statutory financial reporting regulations.
• Extensive knowledge of core health actuarial processes including pricing, valuation, and budgeting/forecasting with a demonstrated knowledge of the capitated delegated model and capitation terms including division of responsibility.
• Thorough knowledge of healthcare delivery systems, integrated delivery systems and medical group practices, especially in a managed care environment, as well as an advanced understanding of key government programs ((Medicare/Medicaid) and market segments (individual, small group, etc.).
• In-depth knowledge of premium rate and benefit pricing methodologies, including a working understanding of health care cost structures (fee schedules, actuarial cost categories, and health care utilization codes).
• Advanced knowledge of key operational functions of a health plan, including expert knowledge of key dimensions of health plan data: Claims, Enrollment, and Revenue.
• Superior business acumen, exceptional analytical and advanced project management skills, with the proven ability to provide innovative solutions to complex problems, reach practical conclusions, and institute effective changes.
• Possess written and verbal communications skills to explain complex health plan regulations and technical information clearly and professionally to diverse audiences.
• Proficiency in a range of actuarial and statistical software packages (e.g., MG-ALFA, SAS) and analytical software (e.g., MedeAnalytics, SAP Crystal Business Intelligence (BI).
• Analyze issues, predict downstream effects, and effectively prevent or resolve problems.
• Work independently as well as be part of an interdisciplinary team, while demonstrating exceptional attention to detail and organizational skills.
• Prioritize and delegate assignments under varied and urgent conditions and work based on experience, procedures, policies, and best practices to achieve objectives and meet deadlines.
• Lead others to solve complex problems using sophisticated analytics to identify innovative solutions.
• Influence individuals or groups with diverse opinions and to enlist cooperation without direct control/authority.
• Ensure the privacy of each patient’s protected health information (phi).
• Build collaborative relationships with peers, other departments, stakeholders, management, and vendors to provide cost-effective healthcare to patients and our health plan members when, where, and how they want it.
• Member, American Academy of Actuaries (MAAA)
• Associate (ASA) or Fellow (FSA) of the Society of Actuaries

Pay Range: $55.42 - $83.13 / hr

 

The salary range for this role may vary above or below the posted range as determined by location. This range has not been adjusted for any specific geographic differential applicable by area where the position may be filled. Compensation takes into account several factors including but not limited to a candidate’s experience, education, skills, licensure and certifications, department equity, training and organizational needs. Base pay is just one piece of the total rewards program offered by Sutter Health. Eligible roles also qualify for a comprehensive benefits package.

Job Shift:

Days

Schedule:

Full Time

Shift Hours:

8

Days of the Week:

Friday, Monday, Thursday, Tuesday, Wednesday

Weekend Requirements:

None

Benefits:

Yes

Unions:

No

This position is work from home eligible.

Position Status:

Exempt

Weekly Hours:

40

Employee Status:

Regular

Number of Openings:

1

Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.

Salary : $55 - $83