Director, Actuarial Services

Job Summary

The Director, Actuarial Services is responsible for the overall management and oversight of staff for all Actuarial tasks. This position is responsible for determining the priorities of requests to Actuarial from within the company as well as from government agencies (Department of Health Care Services (DHCS), Center for Medicare and Medicaid Services (CMS), and L.A. County).  Lead and support lead rates negotiations with Plan Partners, County of Los Angeles, and other major L.A. Care subcontractors. The Director responds to Government requests for data and analyses.  Work with the Accounting/Finance senior management to meet financial reporting and budgeting deadlines. Provide timely assistance to Medical Payment System & Services (MPSS), Provider Network Management (PNM), Legal Enterprise Data Strategy Analytics (EDSA), and any other departments in need of Actuarial support.   Summarize difficult and complex financial situations, edit and update development plans of Actuarial staff and present them to the Chief Financial Officer (CFO).

This position is responsible for directing all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct reports.

Duties

Manage staff , including, but not limited to: monitoring of day to day activities of staff, monitoring of staff performance, mentoring, training, and cross-training of staff, handling of questions or issues, etc. raised by staff, encourage staff to provide recommendations for relevant process and systems enhancements, among others.

Manage Department priorities, including workload analyses, staff availability and skill sets, system requirements, and financial impacts of requests to and demands on the Actuarial Department. 

Prepare briefings, reports, consultation documents and presentations that clearly articulate L.A. Care's regulatory position and policy.  Develop regulatory position and policy based on research and evidence.  Improve and optimize reporting to key departments, including establishing and commutating proposed deadlines, analysis of the amounts and risks involved, project planning, and assignment of project tasks.

Direct and present completed analyses and data reports to government agencies and/or other health plans, develop plans for improved and faster data reporting.

Lead in the analyses and estimated impacts of new Medi-Cal or other (Covered CA, Medicare) programs or inquiries.  Lead in presenting the impact of financial changes to L.A. Care Finance and Senior Management staff, and to major subcontractors' Finance/Actuarial staff.

Prepares briefings, reports, consultation documents and presentations that clearly articulate L.A. Care's regulatory position and policy.  Develop regulatory position and policy based on research and evidence.

Develop goals, objectives and actions plans for assigned staff which includes full management responsibility for the hiring, performance reviews, salary reviews and disciplinary matters for direct reporting employees.

Perform other duties as assigned.

Duties Continued

Education Required

Education Preferred

Experience

Required:

At least 8 years of actuary work experience in a health plan under the supervision of a credentialed Members of the American Academy of Actuaries (MAAA) Actuary.

At least 6 years of experience leading staff or supervisory/management experience. 

Direct involvement and extensive experience with the Finance Department's annual budgeting process, the monthly IBNR reserving process, and the annual Rate Development Template (RDT)/Special Data Request (SDR) submissions process to DHCS. 

Preferred:

Lead roles in both written and/or oral communication with the CA Dept. of Health Care Services, Dept. of Managed Health Care, the U.S. Center for Medicare and Medicaid Services, and the County of Los Angeles.  

Skills

Required:

Thorough understanding of Actuarial Department organization and tasks, financial concepts, and Accounting principles.

Extensive knowledge of the DHCS/Mercer, Covered CA, and Medicare rating methods, as well as the related financial reporting tasks pertaining to the sources of L.A. Care revenue. 

Familiarity with the capitation and other rating procedures for the major L.A. Care subcontractors, particularly involving the Medi-Cal Plan Partners and the County of Los Angeles.  Direct experience in rate negotiations and presentations with these major subcontractors. 

Proven skills with and superior knowledge of the annual budgeting process, the monthly financial reporting process (both Incurred but Not Reported (IBNR) and revenue debits/credits), and responding to government requests for information and explanation.

Demonstrated ability to oversee Actuarial staff in the design and construction of complex Excel spreadsheets.

Effective verbal, written and interpersonal communication skills, including proven excellence in communicating with Senior Management, outside auditors, government rate-setting staff, and other regulatory staff.

Preferred:

Demonstrated ability to explain financial and actuarial concepts to non-Finance staff. 

Patience and businesslike demeanor when challenged or confronted by auditors or regulators who question the work product or methods. 

Superior listening skills.

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Passed at least four Society of Actuaries Exams.

Physical Requirements

Additional Information

Different Areas of Responsibilities:

Government Contracts:

Responsible for the review and negotiation of Medi-Cal rates with DHCS, totally over $10B annually, as well as the development and negotiation of delegated rates of over $3B annually.

As directed by the CFO, support and/or lead the review of revenue amounts from governmental agencies, especially the DHCS Medi-Cal capitation rates for assorted Medi-Cal populations and programs. 

Commercial and Medicare:

Responsible for all Commercial and Medicare Actuarial support, over 700M in reserve estimates, risk adjustment estimates and support for various ad hoc projects across all lines of business.