About this role
We are so glad you are interested in joining Sutter Health!
Organization: SHSO-Sutter Health System Office-Valley Position Overview: Participates in all facets of financial model design, including reserving, rate development, and actuarial data mart development. Provides guidance on a range of topics such as utilization, product pricing including benefit design, premium revenue, and trend forecasting. Monitors and reports on the performance of Commercial business line. Participates as a key financial expert on Sutter Health's customer-facing negotiation team. Partners with information services (IS) to ensure data integrity and integration of the health rules platform and the data warehouse for a scalable, configurable and verifiable data pipeline for healthcare analytics. Job Description: EDUCATION: Equivalent experience will be accepted in lieu of the required degree or diploma.
• Bachelor's in Actuarial Science, Economics, Mathematics or related field
TYPICAL EXPERIENCE:
• 8 years recent relevant experience
SKILLS AND KNOWLEDGE:
• Expertise in Commercial pricing, underwriting, statistical modeling, analytics, networks, forecasting and reserve systems, including expert knowledge of the applicable • Actuarial Standards of Practice (ASoP) issued by Actuarial Standards Board (ASB), generally accepted accounting principles (GAAP) and internal/statutory financial reporting regulations. • Extensive knowledge of core health actuarial processes including pricing, valuation, and budgeting/forecasting with a demonstrated knowledge of the capitated delegated model and capitation terms including division of responsibility. • Thorough knowledge of healthcare delivery systems, integrated delivery systems and medical group practices, especially in a managed care environment, as well as an advanced understanding of key government programs ((Medicare/Medicaid) and market segments (individual, small group, etc.). • In-depth knowledge of premium rate and benefit pricing methodologies, including a working understanding of health care cost structures (fee schedules, actuarial cost categories, and health care utilization codes). • Advanced knowledge of key operational functions of a health plan, including expert knowledge of key dimensions of health plan data: Claims, Enrollment, and Revenue. • Superior business acumen, exceptional analytical and advanced project management skills, with the proven ability to provide innovative solutions to complex problems, reach practical conclusions, and institute effective changes. • Possess written and verbal communications skills to explain complex health plan regulations and technical information clearly and professionally to diverse audiences. • Proficiency in a range of actuarial and statistical software packages (e.g., MG-ALFA, SAS) and analytical software (e.g., MedeAnalytics, SAP Crystal Business Intelligence (BI). • Analyze issues, predict downstream effects, and effectively prevent or resolve problems. • Work independently as well as be part of an interdisciplinary team, while demonstrating exceptional attention to detail and organizational skills. • Prioritize and delegate assignments under varied and urgent conditions and work based on experience, procedures, policies, and best practices to achieve objectives and meet deadlines. • Lead others to solve complex problems using sophisticated analytics to identify innovative solutions. • Influence individuals or groups with diverse opinions and to enlist cooperation without direct control/authority. • Ensure the privacy of each patient’s protected health information (phi). • Build collaborative relationships with peers, other departments, stakeholders, management, and vendors to provide cost-effective healthcare to patients and our health plan members when, where, and how they want it. • Member, American Academy of Actuaries (MAAA) • Associate (ASA) or Fellow (FSA) of the Society of Actuaries
Job Shift: Days Schedule: Full Time Days of the Week: Monday - Friday Weekend Requirements: None Benefits: Yes Unions: No Position Status: Exempt Weekly Hours: 40 Employee Status: Regular Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.
Pay Range is $126,256.00 to $189,384.00 / annual salary The compensation range may vary based on the geographic location where the position is filled. Total compensation considers multiple factors, including, but not limited to a candidate’s experience, education, skills, licensure, certifications, departmental equity, training, and organizational needs. Base pay is only one component of Sutter Health’s comprehensive total rewards program. Eligible positions also include a comprehensive benefits package.