Job Description

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 analysis, and actuarial data mart development. Provides guidance on a range of topics such as utilization, product pricing including benefit design, contracting, premium revenue, and trend forecasting. Monitors and reports on the performance of each business line, including Medicare Advantage and preferred provider organization health care plans. Participates as a key financial expert on Sutter Health's customer-facing negotiation team. Contributes to new business activities and new methods of delivering health benefits that enable patients and our health plan members to access care when, where, and how they want it. 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. This is a hybrid role with both work from home and onsite requirements. The successful candidate will live in the Sutter footprint. **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:** + 5 to 8 years of recent and relevant actuarial experience + ASA preferred + Member, American Academy of Actuaries (MAAA) preferred **SKILLS AND KNOWLEDGE:** + Expertise in actuarial 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 which include SQL and Excel Visual Basic (VBA) skills. + 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. **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 $60.70 to $91.05 / hour _The salary range for this role may vary above or below the posted range as determined by location. This range has not been adjusted for any specific geographic differential applicable by area where the position may be filled. Compensation takes into account several factors including but not limited to a candidate's experience, education, skills, licensure and certifications, department equity, training and organizational needs. Base pay is just one piece of the total rewards program offered by Sutter Health. Eligible roles also qualify for a comprehensive benefits package._ _​_

Job Tags

Full time, Live in, Work at office, Monday to Friday, Shift work, Weekend work,

Similar Jobs