Organization:
SHSO-Sutter Health System Office-Valley
Position Overview:
Responsible for overseeing all facets of pricing analysis and underwriting for Sutter Health Plan. Will dedicate a significant amount of time to pricing, product development in support of Sutter Health's strategic growth plan. Oversees the pricing and underwriting departments which are charged with proper premium rates are being charged and negotiated. This role will provide input on company policies, particularly in the area of risk assumption, and provide actuarial assistance on legislative/regulatory matters affecting the company.
Job Description:
EDUCATION:
- Bachelor's degree in a related field such as Finance, Mathematics, Accounting, or equivalent experience
CERTIFICATION & LICENSURE:
- ASA- Associate of the Society of Actuaries
- FSA- Fellow of the Society of Actuaries
TYPICAL EXPERIENCE:
- 6-8 years recent relevant experience
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 i.e., 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.
- 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.
- Work independently as well as be part of an interdisciplinary team, while demonstrating exceptional attention to detail and organizational skills.
Job Shift:
Days
Schedule:
Full Time
Days of the Week:
Monday - Friday
Weekend Requirements:
As Needed
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 $75.45 to $120.73 / 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.