Sutter Health · 12 hours ago
Actuary, Sutter Health Plan
Sacramento, CA
Full-time
Hybrid
Senior Level
$145K/yr - $218K/yr
5+ years expSutter Health is a healthcare organization seeking an Actuary to participate in financial model design and provide guidance on various actuarial topics. The role involves monitoring performance across business lines and contributing to new business activities while ensuring data integrity for healthcare analytics.
Health CareHospitalNon Profit
Responsibilities
Participates in all facets of financial model design, including reserving, rate analysis, and actuarial data mart development
Provides guidance on a range of topics such as utilization, product pricing including benefit design, contracting, premium revenue, and trend forecasting
Monitors and reports on the performance of each business line, including Medicare Advantage and preferred provider organization health care plans
Participates as a key financial expert on Sutter Health's customer-facing negotiation team
Contributes to new business activities and new methods of delivering health benefits that enable patients and our health plan members to access care when, where, and how they want it
Partners with information services (IS) to ensure data integrity and integration of the health rules platform and the data warehouse for a scalable, configurable and verifiable data pipeline for healthcare analytics
Qualification
Required
Bachelor's in Actuarial Science, Economics, Mathematics or related field
5 to 8 years of recent and relevant actuarial experience
Expertise in actuarial pricing, underwriting, statistical modeling, analytics, networks, forecasting and reserve systems, including expert knowledge of the applicable
Actuarial Standards of Practice (ASOP) issued by Actuarial Standards Board (ASB), generally accepted accounting principles (GAAP) and internal/statutory financial reporting regulations
Extensive knowledge of core health actuarial processes including pricing, valuation, and budgeting/forecasting with a demonstrated knowledge of the capitated delegated model and capitation terms including division of responsibility
Thorough knowledge of healthcare delivery systems, integrated delivery systems and medical group practices, especially in a managed care environment, as well as an advanced understanding of key government programs (Medicare/Medicaid) and market segments (individual, small group, etc.)
In-depth knowledge of premium rate and benefit pricing methodologies, including a working understanding of health care cost structures (fee schedules, actuarial cost categories, and health care utilization codes)
Advanced knowledge of key operational functions of a health plan, including expert knowledge of key dimensions of health plan data: Claims, Enrollment, and Revenue
Superior business acumen, exceptional analytical and advanced project management skills, with the proven ability to provide innovative solutions to complex problems, reach practical conclusions, and institute effective changes
Possess written and verbal communications skills to explain complex health plan regulations and technical information clearly and professionally to diverse audiences
Proficiency in a range of actuarial and statistical software packages which include SQL and Excel Visual Basic (VBA) skills
Analyze issues, predict downstream effects, and effectively prevent or resolve problems
Work independently as well as be part of an interdisciplinary team, while demonstrating exceptional attention to detail and organizational skills
Prioritize and delegate assignments under varied and urgent conditions and work based on experience, procedures, policies, and best practices to achieve objectives and meet deadlines
Lead others to solve complex problems using sophisticated analytics to identify innovative solutions
Influence individuals or groups with diverse opinions and to enlist cooperation without direct control/authority
Ensure the privacy of each patient's protected health information (phi)
Build collaborative relationships with peers, other departments, stakeholders, management, and vendors to provide cost-effective healthcare to patients and our health plan members when, where, and how they want it
Preferred
ASA preferred
Member, American Academy of Actuaries (MAAA) preferred
Benefits
Comprehensive benefits package
Company
Sutter Health
Sutter Health is a non-profit organization operating a network of hospitals and physicians in Northern California.
10001+ employees
Funding
Current Stage
Late StageTotal Funding
$27.17MKey Investors
Department of Health Care Services
2025-05-19Grant· $23M
2016-11-22Grant· $1.2M
2013-10-09Grant· $2M
Leadership Team
Megan Gillespie
Chief Executive Officer
Warner L. Thomas
Chief Executive Officer
Recent News
2025-11-19
2025-11-19
Company data provided by crunchbase