Manager, Actuarial Services – Commercial, Medicare
L.A. Care Health Plan
full-time
Posted on:
Location Type: Office
Location: Los Angeles • California • United States
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Salary
💰 $135,136 - $216,218 per year
About the role
- Manage the Monthly Financial Reporting and Analysis
- Review reports to ensure consistency and appropriateness of methodologies used
- Ensure actuarial assumptions, methodologies, and documentation meet regulatory standards
- Interpret results and recommend solutions to identified issues
- Provide assistance in ad-hoc projects related to rate filings, new business development, financial projections, budgeting, and acquisitions
- Oversee the production, validation, and documentation of actuarial reports along with shared risk settlement estimates and regular analyses of revenue and cost trends across benefits and programs
- Manage risk score data analysis and reporting for all lines of business
- Review rates and other at-risk payments from DHCS, CMS, Covered CA, or other governmental agencies
- Manage staff, including monitoring of day-to-day activities of staff, performance, mentoring, training, and cross-training of staff
- Engage and update key stakeholders, develop timelines, and ensure implementation upon approval
Requirements
- Bachelor's Degree in Mathematics or Related Field
- At least 7 years of actuarial experience in health insurance or managed care environment
- At least 4 years of leading staff or supervisor/management experience
- Experience leading teams, projects, initiatives, or cross-functional groups
- Experience with risk adjustment models (CDPS+Rx, CMS-HCC, RxHCC, etc.) and provider payment methodologies
- Experience with at least one major line of business: Medical, Medicare Advantage / Dual Eligible Special Needs Plan (D-SNP), or Commercial
Benefits
- Paid Time Off (PTO)
- Tuition Reimbursement
- Retirement Plans
- Medical, Dental and Vision
- Wellness Program
- Volunteer Time Off (VTO)
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
financial reportingactuarial analysisrisk adjustment modelsprovider payment methodologiesbudgetingfinancial projectionsdata analysisreport validationdocumentationrate filings
Soft Skills
staff managementmentoringtrainingcross-trainingstakeholder engagementcommunicationproblem-solvingleadershipproject managementorganizational skills