Manager, Actuarial Services (Commercial, Medicare)
Medicare AdvantageCommercial Employer HealthMedicaidRegulatory ReportingPredictive Modelling & MLBusiness Intelligence & Reporting
Role Summary
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Manager-level health actuarial role at L.A. Care focusing on Commercial and Medicare lines. You’ll oversee monthly financial reporting, regulatory filings (DHCS/CMS/Covered CA), and risk-adjustment modelling while managing a team in Los Angeles, CA.
JOB DESCRIPTION SUMMARY
- Manage monthly financial reporting, analyses, and actuarial documentation
- Oversee risk-adjustment models and shared-risk settlement estimates
- Review DHCS, CMS, and Covered CA rates and at-risk payment agreements
- Hire, supervise, coach, and develop actuarial staff
- Lead complex projects and coordinate cross-functional stakeholders
DOMAIN EXPERTISE
- Actuarial experience in health insurance or managed care
- Supervisory or management experience leading actuarial staff
- Risk adjustment modelling (CDPS+Rx, CMS-HCC, RxHCC)
- Experience with Medicare Advantage, Commercial, or Medicaid
KEY REQUIREMENTS
- 7+ years actuarial experience in health insurance or managed care
- 4+ years of supervisory or management experience
- ASA and MAAA or at least 4 Associate exams passed
- Experience with risk adjustment models (CDPS+Rx, CMS-HCC, RxHCC)
- Proficient with SQL, SAS, R, Python and advanced Excel; Power BI
TECH STACK
- Excel
- Power_BI
- SAS_Enterprise_Guide
- PowerPoint
