Director, Actuarial Services - Risk Analytics

Position Summary/Position

This Director is responsible for risk revenue management for Medi-Cal and ACA products. This includes, but not limited to, development and overseeing programs to ensure comprehensive and accurate diagnosis coding for Medi-Cal and ACA products.  Utilize analytics to identify trends and opportunities for risk revenue optimization. This position collaborates with other IEHP business units in planning and implementing risk programs. This leader will oversee actuarial and coding Team Members to support risk adjustment programs for Medi-Cal and ACA products.

Major Functions (Duties and Responsibilities)

1. Lead risk adjustment valuations, forecasts, and financial modeling for Medi-Cal and ACA (Covered CA) lines of business 
2. Oversee execution of all coding programs and processes, both vendors supplied and internal, for Medi-Cal and Covered CA products
3. Research key risk adjustment trends and provide estimates of the likely financial impact 
4. Deliver executive reporting including finance and business insights and messaging related to risk adjustment that drive incremental business results
5. Work with cross-functional teams to identify, develop and assess the viability of risk adjustment retrospective and/or prospective initiatives
6. Present and lead discussion of results and insights in a collaborative and efficient manner with senior leadership audience
7. Lead teams of analysts and coders to ensure cohesive team culture and effective collaboration with other business units 
8. Maintain deep knowledge and insight of competitive and regulatory landscape, along with research, on various aspects of health care industry

Major Functions (Duties and Responsibilities) Cont

Supervisory Responsibilities

Experience Qualifications

Minimum ten (10) years of actuarial experience in Health Care industry. Proven strategy actuarial or analytic leadership experience in working with cross-functional teams. Data analysis experience in a healthcare setting. Five (5) years of managing experience is required.

Preferred Experience

Risk Adjustment analytics experience is preferred.

Education Qualifications

Bachelor’s degree in Actuarial Sciences, Statistics, Finance, Mathematics, or related field from an accredited institution is required

Preferred Education

Professional Certification

Associate of the Society of Actuaries (ASA) is required; Fellow of the Society of Actuaries (FSA) is preferred.

Professional Licenses

Drivers License Required

Knowledge Requirement

Principles and practices of managed health care industry and strategies. Strong understanding of healthcare market landscape. Knowledge of accounting/finance concepts. Extensive knowledge of MS Excel, Power Point. Knowledge of SQL Programming or relational database is preferred. 

Skills Requirement

Strong conceptual problem-solving skills. Strong quantitative and financial analysis skills. Excellent interpersonal and communication skills (both oral & written). 

Abilities Requirement

Sharp attention to detail, strong work ethic, expansive learner. Ability to work independently and manage a team and take initiative.  Ability to identify and resolve problems, think creatively, strategically and analytically. Ability to apply extensive knowledge of actuarial methods and procedures. Ability to handle multiple competing priorities. Ability to effectively communicate in variety of prestation setting and to influence key stakeholders to drive meaningful change and innovation. Comfortable with senior management audiences, and/or diverse group setting. Strong commitment to quality.  Consistently and thoroughly reviews work for accruing prior to deliverable. 

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

Work Model Location

Physical Requirements