Health Actuary

Dignity Health; Bakersfield (CA); Remote; USD 80,000 - 100,000; Full time

Job summary

An established industry player is seeking a Health Actuary to lead analytics for value-based agreements. This role involves monitoring financial performance and developing innovative strategies to enhance revenue and services. The ideal candidate will have extensive experience in healthcare pricing and contract negotiation, along with strong analytical skills. Join a team dedicated to improving patient care through effective management of healthcare services. This is a fantastic opportunity for those looking to make a significant impact in the healthcare sector while working in a dynamic environment.

Qualifications

• 5+ years in healthcare organizations with experience in pricing and negotiation.
• Strong understanding of value-based arrangements and actuarial principles.

Responsibilities

• Monitor and evaluate value-based payment models and risk arrangements.
• Collaborate to maximize the value of payer contracts and monitor performance.

Skills

Healthcare Pricing

Contract Negotiation

Population Health Analytics

Actuarial Principles

SQL

Excel

Communication Skills

Problem-Solving Skills

Education

Bachelor's Degree in Mathematics

Master's Degree (Preferred)

Job description

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Overview

The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric full-service management service organization structure. We offer a menu of management and business services that leverage economies of scale across provider types and geographies, and lead the development of Dignity Health’s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans, and employers, with a focus on coordinating patient care to contain costs while improving quality and service levels. This is achieved through industry-leading technology and integrated administrative systems powered by local human resources that prioritize patient care.

Responsibilities

• This position is work from home 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 forecasting and monitoring activities that support the transformation to value-based care.

Working with Payer Strategy and Relationships - Analytics and Innovation, this role ensures successful implementation of risk/value-based agreement pricing strategies, assists in opportunity/risk assessments, monitors financial performance, maintains risk profiles, develops actuarial projections, and monitors contract profitability. It also supports creating innovative market and payer strategies to accelerate transition to value-based agreements, optimizing revenue and expanding services.

Responsibilities May Include

• Monitoring and evaluating management of value-based payment models and risk arrangements with payers.
• Assisting in translating value generated from providers and population health programs into contracts and reimbursement models.
• Developing standards and guidelines for value-based payment models and supporting negotiations.
• Monitoring post-negotiation performance of capitation revenue and payer programs.
• Extracting, validating, and analyzing data from multiple sources for operational and clinical reporting.
• Collaborating across departments to maximize the value of payer contracts.
• Managing IBNR calculations, preparing reserve estimates, and documenting assumptions.
• Designing and performing actuarial studies on medical costs and trends.
• Developing reports and analyses to review financial performance of value-based contracts.

Qualifications

Minimum Qualifications:

• At least 5 years’ experience in large healthcare organizations or systems, including 2 years in healthcare pricing, contract negotiation, or healthcare 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 teams.

Preferred Qualifications:

• Experience with IBNR, healthcare forecasting, and reserve valuation.
• Strong problem-solving, critical thinking skills.
• Masters degree and FSA designation preferred.

Pay Range

$49.20 - $71.34 /hour

Additional Details

• Seniority level: Mid-Senior level
• Employment type: Full-time
• Job function: Finance and Sales
• Industries: Hospitals and Healthcare