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Director, Actuarial Services

Date: Apr 3, 2021

Location: Rancho Cucamonga, CA, US

Company: Inland Empire Health Plans

Job Requisition ID: 4788 

 

Position Summary/Position

 

Perform actuarial studies related to medical care costs and trends. Extract medical claim data from various systems, provide related financial analysis and identify trends to support executive decision-making and financial reporting. Lead a team of actuarial analysts to ensure that department goals and objectives are met.

Major Functions (Duties and Responsibilities)

 

1. Provide support for the development of the monthly IBNR estimates by Product/Rate Group. Document assumptions. Analyze results to identify early signs of trends or other issues related to medical care costs.
2. Perform actuarial studies related to medical care costs and trends, as assigned.
3. Generate and distribute various routine reports to support month-end close, IBNP calculations, Risk Corridor, and Monthly Management Report package.
4. Extract and compile various sources of information and large data sets from various systems to create Inpatient/Outpatient/Physician/Other cost and utilization studies.
5. Provide support for the development of reports and analysis for senior management pertaining to areas such as premium, membership, capitation, FFS claims, Encounter claims, pharmacy, authorizations, provider contracting and profitability; communicate analysis and supporting data in a manner that is meaningful to the recipient.
6. Lead gathering claim experience for Rate Development Template (experience data required by CA DHCS that is used by the state's actuary to develop rates) and State regulatory reports
7. Prepare and maintain documentation for the production of standard reporting processes and procedures.
8. Prepare monthly estimates of changes in Medicare revenue resulting from risk adjustment factor (RAF) submissions and annual Part D reconciliation.
9. Assist with report enhancements and modifications, coordinating with other team members as needed.
10. Develop various ad-hoc reports as requested.
11. Lead actuarial efforts that affect new and existing business and determine the impact of various actions on premiums and various product pricing
12. Lead rate submissions and discussions with state and federal regulators
13. Analyze and forecast  medical trends
14. Oversee Actuary Analysts
15. Provide design and oversight of complex actuarial projects
16. Provide Actuarial Certifications as appropriate.

Supervisory Responsibilities

Leader: Administers Hires, Terminations, and Performance Reviews

Experience Qualifications

 

Minimum 10 years of actuarial experience with health insurance or group insurance products. Data analysis experience in a healthcare setting. 5 years of managing experience is required.

Preferred Experience

 

Advanced financial and/or managed care/provider contract modeling experience a plus. 

Education Qualifications

 

Bachelors degree in Health Care Administration, Economics, Accounting, Finance, Mathematics or other related field from an accredited institution required.

Preferred Education

Professional Certification

 

ASA or FSA.

Professional Licenses

Drivers License Required

No

Knowledge Requirement

 

Have some working knowledge of the managed healthcare business.

Principles and practices of managed health care industry and strategies, capitated risk contracting, IBNR, rate setting, claims, provider network structures and risk sharing arrangements.

Familiarity with standard financial reporting structures and experience in the development of health systems reporting tools, including outcomes and performance measures.

Principles and techniques of effective supervision, including training and evaluation.

Skills Requirement

 

Must have strong math and analytical skills. 

High proficiency in MS Access, Excel, Word, and SQL.
Strong leadership skills.
Effective communication skills with ability to analyze complex medical data.
Team player with strong collaboration skills.
Robust analytical and critical thinking skills, with thorough attention to detail.
Savvy with technology and information systems.
Requires good working knowledge of Excel and relational databases/SQL Server.
Ability to create and manage spreadsheets with ease.
Strong understanding of financial concepts.

Abilities Requirement

 

Ability to drive change with strong influencing skills.

Independent thinking, proven track-record of influencing outcomes, and strong sense of ownership.

Ability to build strong relationships across the organization.

Must have strong verbal and written communication skills. 

Effective oral, written and interpersonal communication skills are required.

Commitment to Team Culture

 

The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.

Working Conditions

 

Word processing involving computer keyboard and screens, filing and copying of records and/or correspondence.

Physical Requirements

 

Starting Salary: $181,292.80  - $240,219.20  

Pay rate will commensurate with experience

 

Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region. With a provider network of more than 6,000 and a team of more than 2,000 employees, IEHP provides quality, accessible healthcare services to more than 1.2 million members. And our mission and core values help guide us in the development of innovative programs and the creation of an award winning workplace. As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and Make a Difference with us! IEHP offers a Competitive salary and a benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and retirement plan.

 


Nearest Major Market: Riverside
Nearest Secondary Market: Los Angeles