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Senior Manager, Actuary at Blue Shield of CA in El Segundo, California

Posted in Other 30+ days ago.

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Type: Full Time





Job Description:

At Blue Shield of California we are parents, leader, students, visionaries, heroes, and providers. Everyday we come together striving to fulfill our mission, to ensure all Californians have access to high-quality health care at a sustainably affordable price. For more than 80 years, Blue Shield of California has been dedicated to transforming health care by making it more accessible, cost-effective, and customer-centric. We are a not-for-profit, independent member of the Blue Cross Blue Shield Association with 6,800 employees, more than $20 billion in annual revenue and 4.3 million members. The company has contributed more than $500 million to Blue Shield of California Foundation since 2002 to have a positive impact on California communities. Blue Shield of California is headquartered in Oakland, California with 18 additional locations including Sacramento, Los Angeles, and San Diego. Were excited to share Blue Shield of California has received awards and recognition for LGBT diversity, quality improvement, most influential women in corporate America, Bay Areas top companies in volunteering & giving, and one of the worlds most ethical companies. Here at Blue Shield of California, were striving to make a positive change across our industry and the communities we live in Join us!

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.

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 bachelors 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.

.

EDUCATION:

*

Requires minimum of a bachelors 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.

.

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.