Facility:
City San Diego
Department
Job Status
Regular
Shift
Day
FTE
1
Shift Start Time
Shift End Time
Bachelor's Degree; Associate of the Society of Actuaries (ASA) - Society of Actuaries (SOA)
Hours **:
Shift Start Time:**
8 AM
Shift End Time:
5 PM
AWS Hours Requirement:
8/40 - 8 Hour Shift
Additional Shift Information:
Weekend Requirements:
As Needed
On-Call Required:
No
Hourly Pay Range (Minimum - Midpoint - Maximum):
$76.070 - $98.160 - $120.240
The stated pay scale reflects the range that Sharp reasonably expects to pay for this position. The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant's years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices.
What You Will Do
The Director, Actuarial and Risk Management Services exists to provide strategic leadership for actuarial analysis, risk adjustment, underwriting, and financial forecasting activities that support the health plan's long-term financial performance and regulatory compliance. This role translates complex data into actionable business insights that inform pricing, revenue optimization, product strategy, and enterprise decision-making. The Director collaborates closely with Finance, , Clinical, Operations, and Executive Leadership to ensure accurate risk assessment, sustainable growth, and effective management of healthcare costs. Through actuarial expertise and risk management leadership, this position strengthens the organization's financial stability, competitive position, and ability to deliver high-value healthcare to members.
Required Qualifications
Bachelor's Degree Actuarial Science, Mathematics, Statistics, Finance, Economics, or a related quantitative field
8 Years Progressive health actuarial experience including pricing, forecasting, underwriting, risk adjustment, financial analytics, or related actuarial functions in a health plan, managed care, health insurance, or healthcare consulting environment.
5 Years Leadership or management experience with accountability for professional staff, complex work products, cross-functional initiatives, and strategic business decisions.
3 Years Experience supporting commercial health plan products, rate development, underwriting, pricing, and regulatory filings.
3 Years Experience preparing, reviewing, or overseeing actuarial analyses, financial forecasts, regulatory exhibits, actuarial models, or actuarial certifications.
Associate of the Society of Actuaries (ASA) - Society of Actuaries (SOA) -REQUIRED
Preferred Qualifications
3 Years Experience with ACA risk adjustment, CMS programs, provider risk arrangements, capitation, value-based payment models, or delegated-risk operations.
Other Qualification Requirements
Member of the American Academy of Actuaries (MAAA) - REQUIREDFellow of Society of Actuaries (FSA) - PREFERRED
Essential Functions
Key Responsibilities Strategic Actuarial and Financial Risk LeadershipPricing, Underwriting, and Product StrategyRisk Adjustment Strategy and PerformanceLeadership, Innovation, and Operational ExcellenceServes as a strategic advisor to executive leadership on actuarial, underwriting, risk adjustment, and healthcare finance matters.Represents the organization in industry associations, workgroups, regulatory forums, and external stakeholder meetings.Supports enterprise-wide strategic initiatives, market evaluations, and special projects, as assigned.Performs other duties and responsibilities as assigned.
Pricing, Underwriting, and Financial Management Lead actuarial, underwriting, and commercial pricing activities across applicable lines of business.Manage premium budgeting, rate development, underwriting standards, and pricing recommendations.Evaluate claims experience, utilization trends, benefit design, demographics, provider economics, and other factors affecting pricing and financial performance.Maintain actuarial models, pricing tools, assumptions, and methodologies supporting premium development and benefit pricing.Identify financial risks and recommend strategies to support sustainable performance.
Risk Management/Risk Adjustment Establish and oversee risk adjustment strategy, governance, operating priorities, financial forecasting, accruals, reconciliation, and performance monitoring for applicable programs. Oversee data submission, validation, reconciliation, analytics, documentation, audit readiness, and remediation activities to support complete, accurate, and compliant risk adjustment results.Partner with Clinical Services, Provider Network, Information Technology, Compliance, Finance, and Operations to improve data quality, coding accuracy, documentation, and provider engagement.Provide executive oversight of delegated medical group risk adjustment strategies, including member targeting, outreach approaches, workflow optimization, coding performance, documentation improvement, and performance accountability.Direct performance reporting and analytics used for operational, medical group, physician, executive, and Board-level decision making, including risk score performance, coding opportunities, suspect condition capture, documentation trends, benchmark comparisons, and corrective action planning.
Strategic Analytics and Business Support Conduct actuarial and financial analyses supporting product development, growth opportunities, provider reimbursement arrangements, and strategic initiatives.Evaluate delegated-risk, capitated, and value-based reimbursement arrangements and assess their financial impact.Partner with Finance, Sales, Product, Provider Contracting, Operations, and Compliance to support organizational objectives.Present findings and recommendations to executive leadership and business stakeholders.
Regulatory, Reporting, and Governance Lead actuarial support for California large group rate filings and regulatory inquiries.Support regulatory submissions, audits, surveys, financial reporting, risk adjustment, and medical loss ratio reporting activities.Ensure actuarial and underwriting activities comply with applicable regulations and Actuarial Standards of Practice.Monitor regulatory, market, and healthcare cost trends and evaluate their impact on pricing and underwriting strategies.Coordinate actuarial analyses and filings with external consultants, as appropriate.
Leadership and Operational Excellence Supervise, mentor, and develop actuarial, underwriting, and risk adjustment staff.Establish priorities, review work products, and ensure timely completion of deliverables.Expand internal actuarial capabilities, strengthen documentation standards, and improve processes.Develop automation, reporting tools, and analytic capabilities using available technologies.Serve as a subject matter expert on pricing, underwriting, provider economics, and financial risk.Develop and maintain management reporting to support business performance monitoring.
Knowledge, Skills, and Abilities
Advanced knowledge of health insurance, managed care, and healthcare finance principles.
Advanced knowledge of actuarial methodologies, financial modeling, forecasting, pricing, underwriting, and risk assessment.
Advanced knowledge of risk adjustment programs, coding and documentation practices, and related regulatory requirements.
Knowledge of healthcare reimbursement methodologies, including capitation, shared savings, value-based reimbursement, and delegated-risk arrangements.
Knowledge of healthcare regulations, actuarial standards of practice, rate filings, regulatory reporting, and audit requirements.
Ability to analyze complex financial, actuarial, operational, and regulatory issues and develop effective business solutions.
Ability to interpret and communicate complex technical information to executive leadership, governing bodies, and non-technical audiences.
Ability to develop strategic recommendations that support organizational growth, financial sustainability, and risk management objectives.
Demonstrated leadership, coaching, team development, and performance management skills.
Strong organizational, project management, problem-solving, and decision-making skills.
Ability to establish collaborative relationships and influence outcomes across multiple business functions and leadership levels.
Advanced written, verbal, presentation, and interpersonal communication skills.
Advanced proficiency with Microsoft Excel and financial analytics tools.
Ability to manage multiple priorities and consistently exercise sound independent judgment.
Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class
