Actuary III

Organization: SHSO-Sutter Health System Office-Valley

About the role

Participates in all facets of financial model design, including reserving, rate development, and actuarial data mart development. Provides guidance on a range of topics such as utilization, product pricing including benefit design, premium revenue, and trend forecasting. Monitors and reports on the performance of the Commercial business line. Acts as a key financial expert on Sutter Health's customer-facing negotiation team. Partners with information services (IS) 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.

Requirements

• Bachelor's in Actuarial Science, Economics, Mathematics, or related field (equivalent experience accepted in lieu of degree)
• 8 years of recent relevant experience

Skills and Knowledge

• Expertise in Commercial pricing, underwriting, statistical modeling, analytics, networks, forecasting, and reserve systems, including expert knowledge of Actuarial Standards of Practice (ASoP) issued by the 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 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 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 healthcare cost structures (fee schedules, actuarial cost categories, and healthcare 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 proven ability to provide innovative solutions to complex problems, reach practical conclusions, and institute effective changes
• Strong written and verbal communication skills to explain complex health plan regulations and technical information clearly and professionally to diverse audiences
• Proficiency in actuarial and statistical software packages (e.g., MG-ALFA, SAS) and analytical software (e.g., MedeAnalytics, SAP Crystal Business Intelligence (BI))
• Ability to analyze issues, predict downstream effects, and effectively prevent or resolve problems
• Work independently as well as part of an interdisciplinary team, demonstrating exceptional attention to detail and organizational skills
• Prioritize and delegate assignments under varied and urgent conditions, working 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 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 health plan members
• Member, American Academy of Actuaries (MAAA)
• Associate (ASA) or Fellow (FSA) of the Society of Actuaries

Schedule

• Full-time (40 hours per week)
• Monday - Friday
• No weekend requirements

Pay

Annual salary range: $129,188.80 to $193,793.60. The compensation range may vary based on geographic location, candidate’s experience, education, skills, licensure, certifications, departmental equity, training, and organizational needs.

Benefits

Eligible positions include a comprehensive benefits package as part of Sutter Health’s total rewards program.