Actuary

We are a mission-driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, join us in shaping the future of healthcare as an integral part of our FA - Actuarial Services team.

About the role

This position has been approved for Partial Telework. If telework is approved, you are required to work within the State of California only and, if Partial Telework, come into the Main Office in Orange, CA at least two (2) days per week minimum. The Actuary will ensure the fiscal integrity of CalOptima Health's program and policy decisions and facilitate executive decision-making by providing timely and accurate actuarial and financial analyses. You will be responsible for the ongoing financial planning and analysis needs of the organization, including the review and analysis of revenue, medical costs, and their underlying trends.

Responsibilities

• Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity, and accountability.
• Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
• Provides direction and guidance to Financial Analysis staff in accordance with established departmental and organizational policies.
• Serves as primary liaison with external actuarial services and support.
• Develops clinical utilization, cost profiles, and other indicators for all areas of medical costs, including but not limited to CalOptima Health Direct, pharmacy, and skilled nursing facilities.
• Completes analysis to support regulatory filings, including state rate development models and Medicare Advantage bids.
• Supports operating budget development and monthly reporting analysis.
• Responsible for incurred but not reported reserves (IBNR) modeling and analysis.
• Advises management of significant changes or unusual trends in medical costs and proposes recommendations for management consideration.
• Supports activities related to regulatory and financial audits and findings.
• Assists with the development of appropriate reimbursement rates and other financial contract provisions for CalOptima Health with the state of California.
• Assists in evaluation of decision support and analysis tools, as well as improvements to the data warehouse.
• Supports management with budgeting and forecasting duties.
• Completes other projects and duties as assigned.

Requirements

• Bachelor's degree in health care economics/planning, business, mathematics, or related field PLUS 3 years of health care informatics or actuarial experience required; an equivalent combination of education and experience may also be qualifying.
• Associate of the Society of Actuaries (ASA) certification required.

Qualifications

To succeed in this role, you should possess the following:

• Ability to develop rapport and establish and maintain effective working relationships with leadership, staff, and external contacts at all levels and with diverse backgrounds.
• Work independently and exercise sound judgment.
• Communicate clearly and concisely, both orally and in writing.
• Work a flexible schedule; available to participate in evening and weekend events.
• Organize, be analytical, problem-solve, and possess project management skills.
• Work in a fast-paced environment and in an efficient manner.
• Manage multiple projects and identify opportunities for internal and external collaboration.
• Motivate and lead multi-program teams and external committees/coalitions.
• Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job-specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position.

Physical Requirements

• Ability to visually read information from computer screens, forms, and other printed materials.
• Ability to speak (enunciate) clearly in conversation and general communication.
• Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.
• Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling, and prolonged sitting.
• Lifting and moving objects, patients, and/or equipment 10 to 25 pounds.

Schedule

• This position is from 7:30 am to 4:00 pm daily, with in-office attendance required three (3) days a week on Tuesdays, Wednesdays, and Thursdays.
• The first week of every month, the position will be in the office Monday - Friday from 7:30 am to 4:00 pm daily.

Pay

Our current hiring range is: Pay Grade: 315 - $109,892 - $175,827 ($52.83 - $84.5322). The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role, and internal equity among other factors.

Benefits

• A comprehensive benefits package.
• CalPERS pension program and additional retirement packages.
• A generous PTO program.
• Various wellness programs.
• Tuition reimbursement.
• Professional development opportunities.
• Career development opportunities.
• Flexible scheduling.
• The satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families.

Work Environment

Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. There are no harmful environmental conditions present for this job. The noise level in this work environment is usually moderate.