Manager, Actuarial Services; Commercial, Medicare

Overview

Salary Range: $ (Min.) - $ (Mid.) - $ (Max.)

Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.

Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.

The Manager, Actuarial Services is responsible for the overall management and oversight of staff. This position is responsible for monthly financial reporting and related analysis and reporting; assistance with the submission of health care experience reports and financial regulatory filings to California Department of Health Care Services (DHCS), Centers for Medicare and Medicaid Services (CMS), Covered CA, or other requesting government agencies;

review and analysis of DHCS, CMS, and/or Covered CA payment rates to L.A. Care; work with risk adjustment models for all lines of business; review of financial agreements involving prospective rating or risk adjustment; provide support for company financial projections; support internal departments as needed; and assist the department with all actuarial analyses and documentation as needed.

The Manager manages all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct reports.

Participates and makes recommendation on the department's strategic planning and/or long-term decision-making.

• Manage the Monthly Financial Reporting and Analysis. Review reports to ensure consistency and appropriateness of methodologies used. Ensure actuarial assumptions, methodologies, and documentation meet regulatory standards. Interpret results and recommend solutions to identified issues. Provide assistance in ad-hoc projects related to rate filings, new business development, financial projections, budgeting, and acquisitions. Provide assistance in company financial projections.
• Oversee the production, validation, and documentation of actuarial reports along with shared risk settlement estimates and regular analyses of revenue and cost trends across benefits and programs.
• Manage risk score data analysis and reporting for all lines of business.
• Review rates and other at-risk payments from DHCS, CMS, Covered CA, or other governmental agencies. Review financial agreements involving health care risk.
• Manage staff, including, but not limited to monitoring of day-to-day activities of staff, monitoring of staff performance, mentoring, training, and cross-training of staff, handling of questions or issues, etc. raised by staff, encourage staff to provide recommendations for relevant process and systems enhancements, among others.
• Manage complex projects, engaging and updating key stakeholders, developing timelines, lead others to complete deliverables on time and ensure implementation upon approval.
• Responsible for reporting, budgeting, and policy implementation.
• Perform other duties as assigned.

Education Required: Bachelor's Degree in Mathematics or Related Field. In lieu of degree, equivalent education and/or experience may be considered.

Education Preferred: Master's Degree in Mathematics or Related Field.

Experience

Required:

At least 7 years of actuarial experience in health insurance or managed care environment; at least 4 years of leading staff or supervisor/management experience; experience leading teams, projects, initiatives, or cross-functional groups. Equivalency:
Completion of the L.A. Care Management Certificate Training Program may substitute for the supervisory/management experience requirement.

Experience Preferred: Experience with risk adjustment models (CDPS+Rx, CMS-HCC, RxHCC, etc.) and provider payment methodologies. Experience with at least one major line of business:
Medical, Medicare Advantage / D-SNP, or Commercial.

• Thorough understanding of health care cost structures (fee schedules, health care cost categories, and health care utilization codes).
• Knowledge of health care industry, including health plans, and providers.
• Deep understanding of delegated risk arrangements, including capitation shared risk settlements, risk corridors, and provider settlements.
• Ability to recruit, develop, and motivate actuarial staff.
• Expertise in evaluating complex data and financial impacts.
• Ability to align actuarial analyses with organizational goals and regulatory requirements.
• Familiarity with probability theory, calculations and applicability to managing financial risk.
• Proficient with SQL, SAS, R, Python, or Power BI; advanced Excel modeling required.
• Strong verbal, written communication and executive-level presentation skills.
• Knowledge of the industry's trends, market…