Manager, Actuarial Services

Job Summary

The Manager, Actuarial Services is responsible for the overall management and oversight of staff. This position is responsible for monthly financial reporting and related analysis and reporting; assistance with the submission of health care experience reports and financial regulatory filings to California Department of Health Care Services (DHCS), Centers for Medicare and Medicaid Services (CMS), Covered CA, or other requesting government agencies;  review and analysis of DHCS, CMS, and/or Covered CA payment rates to L.A. Care; work with risk adjustment models for all lines of business;  review of financial agreements involving prospective rating or risk adjustment;  provide support for company financial projections; support internal departments as needed; and assist the department with all actuarial analyses and documentation as needed.

The Manager manages all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct reports.

Participates and makes recommendation on the department's strategic planning and/or long-term decision-making.

Duties

Manage the Monthly Financial Reporting and Analysis. Review reports to ensure consistency and appropriateness of methodologies used. Ensure actuarial assumptions, methodologies, and documentation meet regulatory standards. Interpret results and recommend solutions to identified issues. Provide assistance in ad-hoc projects related to rate filings, new business development, financial projections, budgeting, and acquisitions.  Provide assistance in company financial projections.       

Oversee the production, validation, and documentation of actuarial reports along with shared risk settlement estimates and regular analyses of revenue and cost trends across benefits and programs.

Manage risk score data analysis and reporting for all lines of business.

Review rates and other at-risk payments from DHCS, CMS, Covered CA, or other governmental agencies. Review financial agreements involving health care risk.     

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 complex projects, engaging and updating key stakeholders, developing timelines, lead others to complete deliverables on time and ensure implementation upon approval.

Responsible for reporting, budgeting, and policy implementation.

Perform other duties as assigned.

Duties Continued

Education Required

Education Preferred

Experience

Required:

At least 7 years of actuarial experience in health insurance or managed care environment.

At least 4 years of leading staff or supervisor/management experience.

Experience leading teams, projects, initiatives, or cross-functional groups.

Equivalency:  Completion of the L.A. Care Management Certificate Training Program may substitute for the supervisory/management experience requirement.

Preferred:

Experience with risk adjustment models (CDPS+Rx, CMS-HCC, RxHCC, etc.) and provider payment methodologies.

Experience with at least one major line of business: Medical, Medicare Advantage / Dual Eligible Special Needs Plan (D-SNP), or Commercial.

Skills

Required:

Thorough understanding of health care cost structures (fee schedules, health care cost categories, and health care utilization codes).

Knowledge of health care industry, including health plans, and providers.

Deep understanding of delegated risk arrangements, including capitation shared risk settlements, risk corridors, and provider settlements.

Ability to recruit, develop, and motivate actuarial staff.

Expertise in evaluating complex data and financial impacts.

Ability to align actuarial analyses with organizational goals and regulatory requirements.

Familiarity with probability theory, calculations and applicability to managing financial risk.

Proficient with SQL, SAS, R, Python, or Power BI; advanced Excel modeling required.

Strong verbal, written communication and executive-level presentation skills.

Knowledge of the industry's trends, market dynamics, directions, major issues, regulatory considerations and trendsetters.

Knowledge of finance, accounting and actuarial concepts and practices as applied to the industry.

Strong interpersonal skills for building relationships, fostering teamwork, and creating a positive work environment. Ability to guide and support team members.

Excellent ability to set clear goals, develop strategic plans to achieve those goals, and inspire others to work towards a shared vision.

Skilled in mediating disputes and resolving conflicts in a fair and constructive manner.

Must have a deep understanding of financial principles.

Ability and excellent knowledge in developing and managing budgets, forecasting future financial outcomes, and making informed decisions about resource allocation.

Ability to make informed decisions.

Deep understanding of organizational operations to identify opportunities and navigate challenges.

Strong ability and knowledge to analyze market trends, anticipate future changes, and develop long-term strategies that align with the company's goals.

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Physical Requirements

Additional Information