Your Role
The Sr.
Principal Actuarial Analyst for our Medi-Cal team is responsible for overseeing rate development & rate analysis, Medi-Cal program analysis, experience reporting, and Medi-Cal program strategy.
This position requires directly managing 1 actuarial analyst and partnering with Senior Leadership and cross-functional teams to drive successful strategy and analytics.
This role will report directly to the Senior Director of Medicare Finance & CFO Promise Health Plan.
Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially.
We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.
Your Work
In this role, you will:
Rate Development/Analysis; Influence & Negotiation
Be responsible for developing, updating, and evaluating all rate packages from DHCS including development factors, trend support, actuarial assumptions, program analysis, and risks or opportunities
Report to the CFO of Promise Health Plan and senior executives of Promise Health Plan financial opportunities and areas of focus for performance optimization
Assist with, and influence, rate negotiation and rate guidance
Revenue & Cost of Healthcare Forecasting for Medi-Cal / Promise Health Plan
Develop, implement, manage and own advanced analytics projects from end to end and proactively add improvements and enhancements
Explain and influence the project to audiences outside the job function and to senior leaders.
Will drive and ensure alignment of project with team goals and long-term strategic goals
Conduct and develop analysis, assess risk and population risk scores and assignment, develop pricing and trends, assess changes in benefit designs, develop reserves, perform forecasting, analyze provider reimbursement terms and/or evaluate actuarial risk related analysis
Medi-Cal Program Actuarial Support & Revenue optimization
Financial and Actuarial Process support and Talent development
Medi-Cal strategy development & program planning
Acts as the lead subject matter expert in the data areas of claim, premium, membership, and/or risk score assignment
Work closely with Senior Leadership at Promise Health Plan to understand strategic direction and financial strengths and opportunities
Partner with financial and actuarial leaders to strengthen finance and actuarial processes and build strong talent pipelines
Partner with CFO of Promise Health Plan on annual budget setting process and on-going forecasting processes
Responsible for evaluating and explaining monthly financial variances to plan for revenue and cost of healthcare
Understand the core principles and act as an expert within a specialized discipline, along with the functionality underlying decision, descriptive, predictive and prescriptive advanced analytic methods
Your Knowledge and Experience
Requires college degree in mathematics, statistics, computer science or equivalent business experience
Requires 8 years of professional health actuarial experience.
Requires a minimum of 5 years of experience in health actuarial pricing
Requires an ASA, may have FSA designation, must be working towards FSA if not complete
Requires extensive knowledge of job area (including health plan operations) and regulations obtained through professional experience and advanced education.
Requires a mastery level knowledge within the Actuarial job area and may have deeper knowledge of project management.
Requires a high proficiency in applied statistics skills, such as distributions, statistical testing, and regression
Requires the ability to program in SQL, SAS and/or Tableau, and experience with common data science toolkits such as R and Python
Requires a business level, functional exposure to three or more machine learning algorithms such as random forest, decision trees, clustering, generalized linear models, principle component analysis
Pay Range:
The pay range for this role is: $ 172260.00 to $ 258280.00 for California.
Note:
Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade.
Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.