Actuarial Analyst V - Network Pricing experience

Kaiser Permanente; Pasadena (CA); On-site; USD 150,000 - 190,000; Full time

Job summary

Kaiser Permanente in Pasadena seeks an experienced Network Pricing Actuary to lead regional analytics supporting contract negotiations and network strategy. This individual contributor role requires actuarial expertise, collaboration with cross-functional teams, and strong communication with senior leadership.

The position focuses on modeling, financial risk assessment, and guidance on pricing decisions to improve network performance and cost trends.

Qualifications

• Bachelor's degree in mathematics or related field required.
• Actuarial certification (CAS/SOA) preferred.
• Minimum eight years actuarial experience; healthcare/insurance background is beneficial.

Responsibilities

• Lead analyses to influence negotiation strategy for major deals across networks.
• Coordinate and perform modeling to support major negotiations.
• Present findings to leadership and cross-functional teams.
• Develop evaluations of product line performance, reserves, and cash flow analyses.
• Mentor and coach analysts within the network pricing team.

Skills

Ambiguity management

Attention to detail

Communication

Critical thinking

Cross-group collaboration

Decision making

Organizational savvy

Problem solving

Education

Bachelor's degree in mathematics or related field

CAS/SOA Associate certificate

Tools

Statistical programming language

Databases & spreadsheets

Excel

Job description

The Network Pricing Actuary is part of the growing Network Pricing team, which partners with the national and local market Provider Contracting teams to ensure our contract negotiations, network strategy, and understanding of our network performance are informed by reliable data and modeling. This role serves as the regional lead, responsible for work including: coordinating and presenting analyses to influence our negotiation strategy for major deals; coordinating and performing modeling to support major negotiations; facilitating market network performance management forums, bringing insights into network performance drivers and opportunities, and driving accountability; and partnering with the provider contracting and delivery system teams to develop the network strategy. This is a leadership level role that will engage regularly with the VPs of provider contracting, the market CFOs, and the regional health plan SVP. While not having any direct reports, this role will partner closely with the network pricing analysts in the team, delegating analysis and providing guidance and coaching. The work will require knowledge and experience of provider contracting, network strategy, and how they impact unit cost trends and product & network financial performance.

Job Summary:

This individual contributor is primarily responsible for researching and determining the likelihood of financial risk to the organization, aligning actuarial documentation with financial reports and tax returns, developing and designing product line evaluations and actuarial models, and assessing, analyzing, and interpreting financial risk and opportunity.

Essential Responsibilities:

• Practices self-leadership and promotes learning in others by building relationships with cross-functional stakeholders; communicating information and providing advice to drive projects forward; influencing team members within assigned unit; listening and responding to, seeking, and addressing performance feedback; adapting to competing demands and new responsibilities; providing feedback to others, including upward feedback to leadership and mentoring junior team members; creating and executing plans to capitalize on strengths and develop weaknesses; and adapting to and learning from change, difficulties, and feedback.
• Conducts or oversees business-specific projects by applying deep expertise in subject area; promoting adherence to all procedures and policies; developing work plans to meet business priorities and deadlines; determining and carrying out processes and methodologies; coordinating and delegating resources to accomplish organizational goals; partnering internally and externally to make effective business decisions; solving complex problems; escalating issues or risks as appropriate; monitoring progress and results; recognizing and capitalizing on improvement opportunities; and evaluating recommendations made by others.
• Completes actuarial documentation by reviewing and coordinating the actuarial portion of financial reports and tax returns, and responses to insurance regulations; and presenting results internally to mid-level leadership.
• Develops and designs product line evaluations by interpreting and communicating findings of analysis of product line financials, reserve, valuation , cash flow analysis; and interpreting product line performance, risk, and assumptions used in product development.
• Designs and develops actuarial research by designing complex methods to advance standards, assumptions, and the legal and regulatory environment.
• Assesses, analyzes and interprets financial risks and opportunities by using non-traditional actuarial methods and actuarial judgment when conducting actuarial analyses.
• Leads collaboration with business partners by translating complex actuarial constructs into actionable recommendations; and developing and formulating accurate actuarial and financial advice in compliance with the Actuarial Standards of Practice.
• Creates framework and assumptions for new, existing, and non-traditional actuarial models to meet business needs.

Knowledge, Skills and Abilities: (Core)

• Ambiguity/Uncertainty Management
• Attention to Detail
• Business Knowledge
• Communication
• Critical Thinking
• Cross-Group Collaboration
• Decision Making
• Dependability
• Diversity, Equity, and Inclusion Support
• Drives Results
• Facilitation Skills
• Health Care Industry
• Influencing Others
• Integrity
• Learning Agility
• Organizational Savvy
• Problem Solving
• Short- and Long-term Learning & Recall
• Teamwork
• Topic-Specific Communication

Knowledge, Skills and Abilities: (Functional)

• Analytical Skills
• Client Focus
• Debugging and Troubleshooting
• Demonstrating Personal Flexibility
• Economics
• Getting Work Done Through Others
• Initiative
• Maintain Files and Records
• Managing Diverse Relationships
• Mathematics
• Negotiation
• Organizational Skills
• Project Management
• Statistical Programming Language
• Stress Tolerance
• Technical Communication
• Trust

Minimum Qualifications:

• Bachelors degree in mathematics or related field AND Minimum eight (8) years actuarial experience. Additional equivalent work experience in a directly related field may be substituted for the degree requirement.

• Associate of the Casualty Actuarial Society Certificate OR Associate of the Society of Actuaries Certificate

Preferred Qualifications:

• Two (2) years experience in a leadership role with or without direct reports.
• Six (6) years experience with databases and spreadsheets.