Actuary

**Join Us in this Amazing Opportunity** **The Team You’ll Join** We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all. **More About the Opportunity** We are hoping you will join us as a **Actuary** and help shape the future of healthcare where you’ll be an integral part of our **FA - Actuarial Services** team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. This position has been approved to be **Partial Telework**. - *If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum.* The Actuary will ensure the fiscal integrity of CalOptima Health’s program and policy decisions and facilitate executive decision making by providing timely and accurate actuarial and financial analyses. You will be responsible for the ongoing financial planning and analysis needs of the organization, including the review and analysis of revenue, medical costs and their underlying trends. Together, we are building a stronger, more equitable health system. **Your Contributions To the Team:** - 80% - Financial Analysis Support - Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. - Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. - Provides direction and guidance to Financial Analysis staff in accordance with established departmental and organizational policies. - Serves as primary liaison with external actuarial services and support. - Develops clinical utilization, cost profiles and other indicators for all areas of medical costs, including but not limited to CalOptima Health Direct, pharmacy and skilled nursing facilities. - Completes analysis to support regulatory filings, including state rate development models and Medicare Advantage bids. - Supports operating budget development and monthly reporting analysis. - Responsible for incurred but not reported reserves (IBNR) modeling and analysis. - Advises management of significant changes or unusual trends in medical costs and proposes recommendations for management consideration. - Supports activities related to regulatory and financial audits and findings. - Assists with the development of appropriate reimbursement rates and other financial contract provisions for CalOptima Health with the state of California. - Assists in evaluation of decision support and analysis tools, as well as improvements to the data warehouse. - Supports management with budgeting and forecasting duties. - 5% - Other - Completes other projects and duties as assigned. **Do You Have What the Role Requires?** - Bachelor’s degree in health care economics/planning, business, mathematics or related field PLUS 3 years of health care informatics or actuarial experience required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. **You’ll Stand Out More If You Possess the Following:** - Master’s degree in health care economics/planning, business, mathematics or related field required. **What the Regulatory Agencies Need You to Possess?** - Associate of the Society of Actuaries (ASA) certification required. **Your Knowledge & Abilities to Bring to this Role:** - Develop rapport and establish and maintain effective working relationships with CalOpti…