Manager, Actuarial Services
Medicare AdvantageMedicaidCommercial Employer HealthRegulatory ReportingRisk Management, ERM & ORSABusiness Intelligence & Reporting
Role Summary
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Manager-level health actuarial role at L.A. Care Health Plan in Los Angeles. You will lead actuarial services including monthly financial reporting, regulatory filings (DHCS/CMS/Covered CA), risk adjustment model oversight, and staff management. Role requires strong experience in managed care, risk adjustment, and financial projections.
JOB DESCRIPTION SUMMARY
- Manage monthly financial reporting and actuarial analyses for a large health plan
- Oversee risk adjustment models (e.g., CMS-HCC, RxHCC, CDPS+Rx) and risk-score analysis
- Lead a team of actuarial staff; hiring, coaching, performance management
- Support regulatory filings to DHCS, CMS, and Covered CA
- Role based in Los Angeles; requires 7+ years in health actuarial and management experience
DOMAIN EXPERTISE
- Actuarial experience in health insurance or managed care
- Four or more years of supervisory or management experience
- Experience with risk adjustment models and provider payment methodologies
- Thorough understanding of health care cost structures and capitation/shared risk arrangements
KEY REQUIREMENTS
- At least 7 years of actuarial experience in health insurance or managed care
- At least 4 years of supervisory or management experience
- ASA and MAAA or at least 4 associate exams passed required
- Proficiency with SQL, SAS, R, Python or Power BI and advanced Excel modeling
- Experience with risk adjustment models and provider payment methodologies
TECH STACK
- Power_BI
- Excel
- PowerPoint
