Senior Manager, Actuary

Blue Shield Of California El Segundo , CA 90245

Posted 2 months ago

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.

Responsibilities:

  • 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.

Education:

  • 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

Computer Skills:

  • Programming knowledge required

  • SAS/SQL knowledge required.

  • Proficiency with MS Office (Excel, Access, Word, Powerpoint, and Visio)

Personal/Leadership Skills:

  • 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

Preferred experience:

  • 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.

.


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Senior Manager, Actuary

Blue Shield Of California