This position will provide actuarial analysis on projects and will also support the Financial Analysis and other departments throughout CalOptima. This position will develop and design reports, as well as create and maintain databases to support business requirements of the team and continually improve data acquisition and reporting methods.
Prepare, analyze, and report the monthly Incurred But Not Reported (IBNR) reserve estimate.
Prepare the semi-annual Chronic Illness & Disability Payment System (CDPS) risk score, analyze, and report the financial impact for the risk score adjusted capitation rate.
Prepare the annual rate development template/bid for all lines of business.
Generate and analyze monthly enrollment, claims, and utilization reports.
Assist the Accounting department in preparing reports related to claims data and/or reserve estimation for internal and external auditors.
Design reports from the data warehouse as needed and be responsible for the assurance of data integrity.
Analyze and assist in making recommendations regarding the monthly IBNR reserve estimate and the financial aspects of certain major policy issues.
Cross-train as backup for various departmental functions.
Assist with ad-hoc analysis.
Other projects and duties as assigned.
Work independently with strong initiative and follow-through on projects with minimal supervision or guidance.
Analyze performance and make recommendations based on analysis.
Develop and maintain effective working relationships with all levels of staff and health network partners.
Communicate effectively at all organizational levels.
Work cooperatively and effectively on group projects.
Excellent organizational skills and the ability to prioritize tasks and use time efficiently.
Experience & Education:
Bachelor’s degree in Actuarial Science, Business Administration, Finance, Economics, Mathematics or other related field highly desired. Master’s degree a plus.
Minimum two actuarial exams.
Minimum two years of actuarial experience preferred.
Experience with managed health care programs and financial modeling strongly preferred.
Must be comfortable working in a dynamic environment with both short-term and long-term deadlines.
Microsoft SQL Server/Access- to create ad-hoc reports and design databases; strong competence with the process of data retrieval from data warehouses and databases.
Microsoft Excel- to manipulate data and produce charts/reports applicable to reporting requests.
Managed care, Medicare and Medicaid concepts.
Technical knowledge and methods in preparing IBNR, financial statements, forecasts, projections, and other health system reporting tools, including performance measures highly desired.
Senior-level data quality assessment and analysis skills.
Analytical and problem-solving skills.
VBA knowledge preferred.
Orange, California, United States
Website : http://www.caloptima.org/
Better. Together. Our mission is to provide members with access to quality health care services delivered in a cost-effective and compassionate manner. CalOptima is a county organized health system that administers health insurance programs for low-income families, children, seniors and persons with disabilities in Orange County. As the second largest health insurer in Orange County, we provide coverage to one in seven residents and almost a third of our community's children through three major programs.