Actuary, Sutter Health Plan

Sutter Health • Sacramento, CA

6d

About The Position

Participates in all facets of financial model design, including reserving, rate analysis, and actuarial data mart development. Provides guidance on a range of topics such as utilization, product pricing including benefit design, contracting, premium revenue, and trend forecasting. Monitors and reports on the performance of each business line, including Medicare Advantage and preferred provider organization health care plans. Participates as a key financial expert on Sutter Health's customer-facing negotiation team. Contributes to new business activities and new methods of delivering health benefits that enable patients and our health plan members to access care when, where, and how they want it. 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
• 5 to 8 years of recent and relevant actuarial experience
• 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 which include SQL and Excel Visual Basic (VBA) skills.
• 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.

Nice To Haves

• ASA preferred
• Member, American Academy of Actuaries (MAAA) preferred

Responsibilities

• Participates in all facets of financial model design, including reserving, rate analysis, and actuarial data mart development.
• Provides guidance on a range of topics such as utilization, product pricing including benefit design, contracting, premium revenue, and trend forecasting.
• Monitors and reports on the performance of each business line, including Medicare Advantage and preferred provider organization health care plans.
• Participates as a key financial expert on Sutter Health's customer-facing negotiation team.
• Contributes to new business activities and new methods of delivering health benefits that enable patients and our health plan members to access care when, where, and how they want it.
• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees