Hybrid Manager, Actuary bei Blue Shield of California Group
Blue Shield of California Group · Oakland, Vereinigte Staaten Von Amerika · Hybrid
- Senior
- Optionales Büro in Oakland
Your Role
The Risk Adjustment team is hiring a Manager of Risk Adjustment Retrospective Analytics. The Manager, Actuary will report to the Vice President of Risk Adjustment. In this role you will have end-to-end oversight of the Medicare Chart, ACA Chart, and RADV data analytics which will involve leading a team of analysts to support chart chase creation for medical records retrieval and coding of retrieved charts and ensure complete and accurate supplemental submission. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.
Responsibilities
Your Work
In this role, you will:
- Have overall responsibility and accountability for reviewing staff work product related to reserving, CMS/ACA related risk adjustment processes, pricing, forecasting, trend setting, and/or network development and alternative provider payment models
- Be responsible for developing and managing experience tracking reports, comparisons to plan, tracking and quantifying variances and shares insights with the business unit and management
- Ensure team follows existing workflow procedures or policies and/or validate or develop new procedures and policies
- Be responsible for understanding current and emerging regulatory and competitive developments, facilitating communication of these developments, and ensuring processes and procedures are consistent with changing regulations
- Lead special projects/ committees/task forces
Lead a team of 7 analysts to ensure encounter data being sent to CMS is complete and accurate. This oversight is done through reviewing 500K+ medical encounters for chart chase (through a chart retrieval/coding vendor), and ensuring the supplemental data is consistent with the medical record
Program oversight including program updates, financial monitoring, budget tracking, competitor benchmarking, regulation monitoring and compliance, program management including chase list generation and validation, retrieval management, coding management, data submission, final sign-off, vendor oversight management and contracting, maintenance of up-to-date process documentation
Quality assurance oversight of vendor coding accuracy in partnership with Risk Adjustment Coding manager
Qualifications
Your Knowledge and Experience
Requires a bachelor’s degree in actuarial science, mathematics, statistics, computer science or equivalent experience
Requires at least 7 years prior relevant job experience including 3 years of experience operating in a team leader role
Requires an ASA designation or has the majority of the courses completed to receive an ASA designation
Requires 2 years of prior experience managing ACA Chart, MA Chart, ACA RADV, MA RADV, or similar Risk Adjustment retrospective program, or significant evidence of major prior financial or analytical experience and significant evidence of major project management skills.
Requires strong ability to communicate complex technical subjects to non-technical audiences.
Requires strong project and team management skills.
Requires problem-solving skills, self-motivation, detail orientation and critical thinking skills
About Company
About Blue Shield of California
As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.
At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.
Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities – join us!
Our Values:
- Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
- Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
- Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.
Our Workplace Model:
At Blue Shield of California and the Ascendiun Family of Companies, we believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility. As we continue to evolve our workplace model, our focus remains on creating spaces where our people can connect with purpose – whether working in the office or through a hybrid approach – by providing clear expectations while respecting the diverse needs of our workforce.
Two Ways of Working:
- Hybrid (Default): Work from a business unit-approved office at least two (2) times per month (for roles below Director-level) or once per week (for Director-level roles and above). Exceptions:
o Member-facing and approved out-of-state roles remain remote.
o Employees living more than 50 miles from their assigned offices are expected to work with their managers on a plan for periodic office visits.
o For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.
- On-Site: Work from a business unit-approved office an average of four (4) or more days a week.
Physical Requirements:
Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.
Please click here for further physical requirement detail.
Equal Employment Opportunity:
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.
