Health Actuary

Dignity Health; Bakersfield (CA); On-site; USD 90,000 - 130,000; Full time

Job summary

A leading healthcare organization seeks a Health Actuary to support value-based care analytics. The role involves monitoring payment models, collaborating with teams, and requires a Bachelor's degree in mathematics or statistics, along with significant experience in healthcare pricing and contract negotiation.

Qualifications

• 5 years of experience in large healthcare organizations.
• 2 years in healthcare pricing, contract negotiation, or economics.
• Knowledge of value-based arrangements and population health analytics.

Responsibilities

• Monitor and evaluate value-based payment models and risk arrangements.
• Assist in translating value from providers into value-based contracts.
• Collaborate with teams to maximize the value of payer contracts.

Skills

Communication

Problem-solving

Critical thinking

Teamwork

Education

Bachelor's degree in mathematics, statistics, or related field

Master’s degree preferred

Tools

Excel

SQL

Job description

Responsibilities

This position is remote within the Pacific or Mountain time zones.

Position Summary:

The Population Health Services Organization (PHSO) Health Actuary is responsible for post-negotiation capitation and value-based agreement analytics, including routine forecasting and monitoring activities. This role supports CommonSpirit Health’s strategy to transform care delivery through value-based care.

Working in partnership with CommonSpirit Payer Strategy and Relationships - Analytics and Innovation, this role ensures the successful implementation of risk/value-based agreement pricing strategies, assists in compiling opportunity/risk assessments, monitors financial performance, maintains risk profiles, and helps develop actuarial projections. The role also monitors risk contract profitability and assists leadership in creating innovative market and payer strategies to accelerate the transition to value-based agreements, optimize revenue, and increase the number of people served.

The PHSO Health Actuary is a key member of the team, contributing to system and local strategy risk/value-based transformation, risk product pricing, and achieving budget targets.

Responsibilities may include:

1. Monitoring and evaluating value-based payment models and risk arrangements with payers aligned with a value-based strategy.
2. Assisting in translating value generated from providers into value-based contracts and reimbursement models.
3. Supporting the development of standards and guidelines for value-based payment models and assisting in negotiations.
4. Monitoring post-negotiation performance of capitation revenue and reinsurance premiums.
5. Validating data from multiple sources for analyses and reporting.
6. Collaborating with various teams to maximize the value of payer contracts.
7. Managing IBNR calculations and presenting month-end balances.
8. Preparing reserve estimates and documenting assumptions.
9. Designing and performing actuarial studies related to costs and trends.
10. Researching and developing reports on financial performance and communicating results to stakeholders.

Qualifications

Minimum Qualifications:

• At least five (5) years of experience in large healthcare organizations or systems, with two (2) years in healthcare pricing, contract negotiation, or economics.
• Bachelor's degree in mathematics, statistics, or related field.
• Knowledge of value-based arrangements, ACO, and population health analytics.
• Proficiency in Excel and SQL.
• Strong understanding of actuarial principles.
• Excellent communication and presentation skills.
• Ability to work independently and in a team.

Preferred Qualifications:

• IBNR experience.
• Problem-solving skills using sound reasoning.
• Critical thinking skills.
• Experience in healthcare forecasting and reserve valuation.
• Master’s degree preferred.
• Fellow Society of Actuaries (FSA) preferred.

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