Director, Actuarial Services (Director IV)

Director, Actuarial Services (Director IV) Job no: 493809 Work type: Full Time Location: 505 City Parkway West We are hoping you will join us as a Director, Actuarial Services (Director IV) and help shape the future of healthcare. The Director will oversee all actuarial functions, refining information into concise narratives for senior leadership, providing leadership and mentoring staff, and driving data‑driven insights to advance our mission. Responsibilities 45% Leadership Functions: Cultivate and promote a mission‑driven culture of high‑quality performance, with a member focus on customer service, consistency, dignity, and accountability. Direct and assist the team in carrying out department responsibilities and collaborate with the leadership team and staff to support short‑ and long‑term goals/priorities for the department. Direct all aspects of actuarial functions and be accountable for the performance of the team. Maintain policies, procedures and standards for all department activities. Support the Executive Director in departmental budget forecasts as needed. Implement efficiency improvements such as streamlining processes. Lead in the design, development, implementation and maintenance of report suites and dashboards for all levels of CalOptima Health management. Hire, manage, train, support, develop and evaluate direct reports. Perform ongoing staff and workflow analysis; establish plans to ensure the team is adequately staffed. Provide strategic direction and guidance to staff, ensuring responsibilities are carried out in alignment with established departmental and organizational policies. Ensure continuous improvement of knowledge and skill level for all department staff. 45% Financial Support: Serve as subject matter expert in producing and maintaining incurred but not reported (IBNR) reserve estimates for all lines of business to provide the Accounting department with needed information for the month‑end close. Direct the development of appropriate reimbursement rates and other financial contract provisions between CalOptima Health and the state of California; activities include completion of the annual Medi‑Cal rate development template (RDT) and all supplemental data/rate requests as required by the state. Serve as lead authority on provider capitation rate development and pricing adjustments as appropriate. Direct and support the team with the semi‑annual Chronic Illness and Disability Payment System (CDPS) risk adjustment process. Develop actuarial studies and related financial operational processes and analytic tools to leverage system automation and enhance accuracy for actuarial analysis. Inform the Executive Director of significant changes or unusual trends in revenue, utilization and costs and propose recommendations for consideration. 5% Other: Complete other projects and duties as assigned. Qualifications Bachelor’s degree in finance, math, business, statistics, economics, actuarial services or other related field PLUS 7 years of actuarial or analytics experience within health care. An equivalent combination of education and experience may also qualify. 3 years of experience in a finance leadership role responsible for actuarial and/or analytics at a health plan, including direct supervision of staff. Preferred Qualifications Advanced degree in a related field. Tableau or Power BI experience. Experience leveraging artificial intelligence or machine learning for predictive analytics model development. Fellow of the Society of Actuaries (FSA). Regulatory Requirements Associate of the Society of Actuaries (ASA). Knowledge & Abilities Develop rapport and establish effective working relationships with CalOptima Health leadership, staff and external contacts at all levels and with diverse backgrounds. Work independently and exercise sound judgment. Communicate clearly and concisely, both orally and in writing. Work a flexible schedule; available to participate in evening and weekend events. Organize, be analytical, problem‑solve and possess project management skills. Work in a fast‑paced environment and efficiently. Manage multiple projects and identify opportunities for internal and external collaboration. Motivate and lead multi‑program teams and external committees/coalitions. Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job‑specific applications/systems to produce correspondence, charts, spreadsheets, and other information. Physical Requirements Ability to visually read information from computer screens, forms and other printed materials. Ability to speak (enunciate) clearly in conversation and general communication. Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face‑to‑face interactions. Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting. Lifting and moving objects, patients and/or equipment 10 to 25 pounds. Benefits Competitive compensation. Current hiring range: Pay Grade 323 – $204,199 – $326,717 ($98.17 – $157.0756). Full Office (telework eligible in California only). A comprehensive benefits package. CalPERS pension program and additional retirement packages. Additional benefits and perks including generous PTO, work‑life balance, wellness programs, tuition reimbursement, professional development opportunities, career development opportunities, flexible scheduling, and the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families. Equal Opportunity Employment CalOptima Health is an equal‑opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health prohibits unlawful discrimination based on race, religion, color, national origin, ancestry, disability, medical condition, genetic information, marital status, sex, gender identity, gender expression, transition status, age, sexual orientation, immigration status, veteran status, or any other consideration made unlawful by federal, state, or local laws. #J-18808-Ljbffr CalOptima Health