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

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.