Director, Actuary

Sutter Health•Emeryville, CA

About The Position

Responsible for overseeing all facets of actuarial risk analysis and underwriting for all value-based payment relationships for Sutter Health and supporting reinsurance arrangements and other payer risk agreements. Will dedicate a significant amount of time to pricing, product development, medical cost analytics, and valuation in support of Sutter Health’s strategic growth plan and performance of Sutter’s contracted network. Oversees the actuarial and underwriting departments which are charged with maintaining the financial stability of Sutter Health (SH) and its licensed insurance entities ensuring adequate financial reserves are set up, proper premium rates are being charged and negotiated and providing guidance on savings measures related to claims expenses. This role will provide input on company policies, particularly in the area of risk assumption, and provide actuarial assistance on legislative/regulatory matters affecting the company.

Requirements

Bachelor’s degree in a related field such as Finance, Mathematics, Accounting, or equivalent experience
ASA- Associate of the Society of Actuaries OR FSA- Fellow of the Society of Actuaries
6-8 years recent relevant 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 i.e., 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 e.g., MG-ALFA, SAS and analytical software e.g., MedeAnalytics, SAP Crystal Business Intelligence (BI).
Analyze issues, predict downstream effects, and effectively prevent or resolve problems.
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.
Work independently as well as be part of an interdisciplinary team, while demonstrating exceptional attention to detail and organizational skills.