Sr. Manager, Actuary

Sr. Manager, Actuary

Your Role

The Risk Adjustment team within Actuarial is hiring a Senior Manager of Risk Adjustment ACA Chart and RADV Programs. The Senior Manager, Actuarywill report to the Director of ACA Retrospective Programs. In this role you will have end-to-end oversight of the ACA Chart and RADV programs which will involve leading a team of analysts as well as management of vendors to support medical records retrieval and coding of retrieved charts.Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking,buildingand sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Work

In this role, you will:

• Have overall responsibility and accountability for reviewing staff work product related to reserving, CMS/ACA related risk adjustment processes, pricing, forecasting, trend setting, and/or network development and alternative provider payment models
• Be responsible for developing and managing experience tracking reports, comparisons to Plan, tracking and quantifying variances and shares insights with the business unit and management
• Ensure team follows existing work flow procedures or policies and/or validates or developments new procedures and policies
• Be responsible for understanding current and emerging regulatory and competitive developments, facilitating communication of these developments, and ensuring processes and procedures are consistent with changing regulations
• Lead special projects/ committees/task forces
• Lead a team of 6 analysts to run two major Risk Adjustment Retrospective Programs: (1) ACA Chart programs, a $80M annual revenue program, (2) ACA RADV programs, a $40M annual liability program
• Program oversight including program updates, financial monitoring, budget tracking, competitor benchmarking, regulation monitoring and compliance, program management including chase list generation and validation, retrieval management, coding management, data submission, final sign-off, vendor oversight management and contracting, maintenance of up-to-date process documentation
• Quality assurance oversight of vendor coding accuracy in partnership with Risk Adjustment Coding manager
• Vendor contracting for Medicare targeted RADV in partnership with Chief of Staff of Risk Adjustment, and facilitates analytics for Medicare IPM RADV in partnership with Medicare Chart Manager and Risk Adjustment Coding Manager
• Oversees Medi-Cal Encounter Data Validation in partnership with the Quality team and Risk Adjustment Coding Manager

Your Knowledge and Experience

• Requires a bachelor's degree in actuarial science, mathematics, statistics, computer science or equivalent experience
• Requires at least 7 years prior relevant job including 2 years of management experience
• At least 2 years of prior experience managing ACA Chart, MA Chart, ACA RADV, MA RADV, or similar Risk Adjustment retrospective program, or significant evidence of major prior financial or analytical experience and significant evidence of major project management and significant prior vendor contracting and management experience
• Strong ability to communicate complex technical subjects to non-technical audiences
• Strong project and team management skills
• Strong problem-solving skills, self-motivation, detail orientation and critical thinking skills

Pay Range:

The pay range for this role is: $ 145200.00 to $ 217800.00 for California.

Note:

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.