Director, Actuarial Services
Company: Institute for Credentialing Excellence
Location: Rancho Cucamonga
Posted on: April 5, 2021
Institute for Credentialing Excellence (ICE) Inland Empire
Health Plan (IEHP) is the largest not-for-profit Medi-Cal and
Medicare health plan in the Inland Empire. We are also one of the
largest employers in the region. With a provider network of more
than 6,000 and a team of more than 2,000 employees, IEHP provides
quality, accessible healthcare services to more than 1.2 million
members. And our mission and core values help guide us in the
development of innovative programs and the creation of an award
winning workplace. As the healthcare landscape is transformed,
we're ready to make a difference today and in the years to come.
Join our Team and Make a Difference with us! IEHP offers a
Competitive salary and a benefit package with a value estimated at
35% of the annual salary, including medical, dental, vision, team
bonus, and retirement plan. Job Requisition ID: 4788 Starting
Salary: $181,292.80 - $240,219.20 Pay rate commensurate with
experience Position Summary/Position The Director, Actuarial
Services is responsible for performing actuarial studies related to
medical care costs and trends. Extract medical claim data from
various systems, provide related financial analysis and identify
trends to support executive decision-making and financial
reporting. Lead a team of actuarial analysts to ensure that
department goals and objectives are met. Major Functions (Duties
and Responsibilities) 1. Provide support for the development of the
monthly IBNR estimates by Product/Rate Group. Document assumptions.
Analyze results to identify early signs of trends or other issues
related to medical care costs.
2. Perform actuarial studies related to medical care costs and
trends, as assigned.
3. Generate and distribute various routine reports to support
month-end close, IBNP calculations, Risk Corridor, and Monthly
Management Report package.
4. Extract and compile various sources of information and large
data sets from various systems to create
Inpatient/Outpatient/Physician/Other cost and utilization
5. Provide support for the development of reports and analysis for
senior management pertaining to areas such as premium, membership,
capitation, FFS claims, Encounter claims, pharmacy, authorizations,
provider contracting and profitability; communicate analysis and
supporting data in a manner that is meaningful to the
6. Lead gathering claim experience for Rate Development Template
(experience data required by CA DHCS that is used by the state's
actuary to develop rates) and State regulatory reports
7. Prepare and maintain documentation for the production of
standard reporting processes and procedures.
8. Prepare monthly estimates of changes in Medicare revenue
resulting from risk adjustment factor (RAF) submissions and annual
Part D reconciliation.
9. Assist with report enhancements and modifications, coordinating
with other team members as needed.
10. Develop various ad-hoc reports as requested.
11. Lead actuarial efforts that affect new and existing business
and determine the impact of various actions on premiums and various
12. Lead rate submissions and discussions with state and federal
13. Analyze and forecast medical trends
14. Oversee Actuary Analysts
15. Provide design and oversight of complex actuarial projects
16. Provide Actuarial Certifications as appropriate. Requirements
Experience Qualifications Minimum 10 years of actuarial experience
with health insurance or group insurance products. Data analysis
experience in a healthcare setting. 5 years of managing experience
is required. Advanced financial and/or managed care/provider
contract modeling experience a plus.--
Education Qualifications Bachelor's Degree from an accredited
institution required. Professional Certification ASA or FSA.
- Working knowledge of the managed healthcare business.
- Principles and practices of managed health care industry and
strategies, capitated risk contracting, IBNR, rate setting, claims,
provider network structures and risk sharing arrangements.
- Familiarity with standard financial reporting structures and
experience in the development of health systems reporting tools,
including outcomes and performance measures.
- Principles and techniques of effective supervision, including
training and evaluation. Skills Requirement
- Must have strong math and analytical skills.--
- High proficiency in MS Access, Excel, Word, and SQL.
- Strong leadership skills.
- Effective communication skills with ability to analyze complex
- Team player with strong collaboration skills.
- Robust analytical and critical thinking skills, with thorough
attention to detail.
- Savvy with technology and information systems.
- Requires good working knowledge of Excel and relational
- Ability to create and manage spreadsheets with ease.
- Strong understanding of financial concepts. Abilities
- Ability to drive change with strong influencing skills.
- Independent thinking, proven track-record of influencing
outcomes, and strong sense of ownership.
- Ability to build strong relationships across the
- Must have strong verbal and written communication skills.
- Effective oral, written and interpersonal communication skills
are required. Commitment to Team Culture The IEHP Team environment
requires a Team Member to participate in the IEHP Team Culture. A
Team Member demonstrates support of the Culture by developing
professional and effective working relationships that include
elements of respect and cooperation with Team Members, Members and
associates outside of our organization. Job Information
- Job ID: 56349449
- Position Title: Director, Actuarial Services
- Company Name: Inland Empire Health Plan
- Job Function: ASA
- Job Type: Full-Time
- Job Duration: Indefinite
- Min Education: BA/BS/Undergraduate
- Min Experience: Over 10 Years
- Required Travel: 0-10% Inland Empire Health Plan (IEHP) is the
largest not-for-profit Medi-Cal and Medicare health plan in the
Inland Empire. We are also one of the largest employers in the
region. With a provider network of more than 6,000 and a team of
more than 1,900 employees, IEHP provides quality, accessible
healthcare services to more than 1.2 million members. And our
mission and core values help guide us in the development of
innovative programs and the creation of an award winning
workplace.IEHP is proud to celebrate its 21st year of ...View Full
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Keywords: Institute for Credentialing Excellence, Rancho Cucamonga , Director, Actuarial Services, Executive , Rancho Cucamonga, California
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