Department(s): Financial Analysis
Reports to: Executive Director
FLSA status: Exempt
Salary Grade: R - $144,000 - $237,864
Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is on Monday, November 20, 2023 at 11:59 PM. Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date.
About CalOptima Health
CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay!
About the Position
The Manager, Actuary is a key member of the Financial Analysis team who will be responsible for leading the development and communication of financial analyses and metrics to senior leadership to ensure the fiscal integrity of CalOptima Health's program and policy decisions. The incumbent will be responsible for leading all reserving and incurred but not reported (IBNR) related activities, completing annual rate and regulatory filings, assisting in the completion of Medicare bids, development of capitation models and associated risk adjustment methodologies, as well as providing actuarial support for strategic initiatives. The incumbent will be responsible for leading all reserving and incurred but not reported (IBNR) related activities, completing annual rate and regulatory filings, assisting in the completion of Medicare bids, development of capitation models and associated risk adjustment methodologies, as well as providing actuarial support for strategic initiatives. In addition, the incumbent will provide supervision for a team of 3-4 staff members.
Duties & Responsibilities:
- Cultivates and promotes a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
- Directs and assists the team in carrying out department responsibilities and collaborates with the leadership team and staff to support short- and long-term goals/priorities for the department.
- Produces and maintains IBNR reserve estimates for all lines of business to provide the Accounting department with needed information for the month-end close.
- Leads the development of appropriate reimbursement rates and other financial contract provisions between CalOptima Health and the state of California. Activities include completion of the annual Medi-Cal Rate Development Template and all supplemental data/rate requests as required by the state.
- Supports provider capitation rate development and pricing adjustments as appropriate.
- Manages semi-annual Chronic Illness and Disability Payment System (CDPS) risk adjustment process.
- Assists in the completion of annual bid filings for CalOptima Health's Medicare Advantage plans.
- Participates and assists in financial and regulatory audits as necessary.
- Advises management of significant changes or unusual trends in revenue, utilization and costs.
- Proposes recommendations for management consideration.
- Develops/refines actuarial studies and related financial operational processes and analytic tools to leverage system automation and enhance accuracy for actuarial analysis.
- Supports the development of the annual operating budget by providing detailed analysis of medical utilization and unit cost trends across various population groups and categories of service.
- Provides direction and guidance for actuarial staff in performing their duties in accordance with established departmental and organizational policies.
- Completes other projects and duties as assigned.
Experience & Education:
- Bachelor's degree in actuarial science, mathematics, economics, finance or related field required.
- Current member of Associate of Society of Actuaries (ASA) required.
- 5 years of experience in Actuarial Analysis in a health insurance setting required.
- 3 years of supervisory/management experience in a health care environment required.
- An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying.
- Master's degree in actuarial science, mathematics, economics, finance or related field.
- Current member of Fellow of the Society of Actuaries (FSA).
- 5 years of experience in health care finance or informatics.
- Previous experience with Microsoft Structured Query Language (MS SQL) and Tableau.
Physical Demands and Work Environment:
The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Physical demands: Employee must be able to sit for extended periods of time, as well as work at the computer for long periods. Employee is required to use hands and fingers, especially for typing on the computer and using the mouse. Must also be able to reach with hands and arms. Employee must be able to talk and hear, particularly for regular communication on the phone.
- Work Environment: Moderate noise level in a cubicle or office environment.
About our Benefits & Wellness options:
At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Monday or Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options.
CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together.
CalOptima Health is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.
If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.
Job Location: Orange, California
To apply, visit https://jobs.silkroad.com/CalOptima/Careers/jobs/4429
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