This position is within the Medicare Risk Adjustment team within the Actuarial Department and will be leading a small team to ensuring accurate and quality data is submitted to CMS. The Actuarial Manager will have strong technical, project management, and people leadership skills.
Ensure end-to-end reconciliation of claims and encounter data.
Works internally across different departments, including IT, claims, and membership, to resolve data quality gaps.
Works externally with CMS, our vendors/consultants, and industry experts to implement best-in-class practices.
Receives assignments in the form of objectives and establishes goals to meet objectives.
Provides guidance to subordinates.
Responsible for team, department or functional area results in terms of planning, cost and methods.
Ensures work flow procedures and guidelines are clearly documented and communicated.
Establishes and recommends changes to policies which effect subordinate organization(s).
Will lead special projects/committees/task forces.
Requires minimum of a bachelor's degree in a technical or quantitative field (GPA: 3.0 ) or equivalent combination of experience and education.
Requires a minimum of 10 years of healthcare industry experience
Programming knowledge required
SAS/SQL knowledge required.
Proficiency with MS Office (Excel, Access, Word, Powerpoint, and Visio)
Excellent interpersonal, verbal and written communication and presentation skills especially presentations of complex, technical information to non-technical audiences.
Independent problem solver, proactive, able to multitask. Patience for working on large scale problems.
Ability to communicate effectively to leadership
Ability to effectively lead a team of skilled professional
Medicare or Commercial Risk Adjustment Experience
VBA programming knowledge
Finance experience, including revenue and expense accounting
Healthcare Enrollment and Claims processing experience
Other healthcare experience, especially technical experience.
Blue Shield Of California