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.
