CalOptima is a county organized health system that administers publicly funded health care coverage for low-income children, adults, seniors and people with disabilities in Orange County, California. CalOptima’s mission is to provide members with access to quality health care services delivered in a cost-effective and compassionate manner. With $3.2 billion in annual revenue, CalOptima serves nearly 800,000 members, delivering services through 14 health networks. For the past four years, CalOptima has been rated the top quality Medi-Cal plan in California, according to the National Committee for Quality Assurance (NCQA) Medicaid Health Insurance Plan Ratings 2017–2018
The Manager Actuary is a key member of the Financial Analysis team whose responsibility is to lead the development and communication of financial analyses and metrics to senior leadership to ensure the fiscal integrity of CalOptima’s program and policy decisions. The position is responsible for leading all reserving and IBNR related activities, completing annual rate and regulatory filings, assist in the completion of Medicare bids, development of capitation models and associated risk adjustment methodologies, as well as providing actuarial support for strategic initiatives as required. In addition, the position will provide supervision for a team of 3-4 staff members.
• Bachelor’s degree in Actuarial Science, Mathematics, Economics, Finance or other related field.
• Experience in actuarial analysis, preferably in a health insurance setting.
• Minimum of 5 years of healthcare finance or informatics preferred.
• Supervisory experience in a health care environment preferred.
Manager, Actuary must work to:
• 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 actuarial best practices, outcomes and performance measures.
• Principles and techniques of effective supervision, including training and evaluation.
CalOptima’s Manager, Actuary must have the ability to:
• Assess and analyze complex financial and health care data.
• Prepare and present complex financial reports in concise and understandable formats.
• Work with tight deadlines and multiple internal/external customers with competing priorities.
• Communicate effectively at all organizational levels and in situations requiring instructing, persuading, negotiating, consulting, and advising.
• Develop the engagement of subordinate staff.
• Assist in the formulation of policies and procedures; understand and interpret policies, procedures and regulations.
• Proficiently use MS Excel, Access, and Word. MS SQL experience preferred.
• Effectively utilize computer and appropriate software and interact as needed with CalOptima Information Systems.
For a complete job description and to apply online, please go to www.caloptima.org. Questions can be directed to Julie Newman, Senior Recruiter, 714-246-8425 or firstname.lastname@example.org.