Director, Actuarial Services; Director IV

Director, Actuarial Services (Director IV) Overview

Cal Optima a mission‑driven, community‑based organization that serves member health with excellence and dignity, respecting the value and needs of each person. You will join our Financial Analysis team in a full‑office setting, shaping the future of healthcare while advancing our mission through data‑driven insights and operational efficiency.

• 45% – Leadership Functions
  • Cultivates a mission‑driven culture of high‑quality performance with a member focus on customer service, consistency, dignity and accountability.
  • Directs and assists the team in carrying out department responsibilities and collaborates with leadership to support short‑ and long‑term goals.
  • Directs all actuarial functions and is accountable for team performance.
  • Maintains policies, procedures and standards for all department activities.
  • Supports the Executive Director in departmental budget forecasts.
  • Implements efficiency improvements such as streamlining processes.
  • Leads the design, development, implementation and maintenance of report suites and dashboards for all levels of management.
  • Hires, manages, trains, supports, develops and evaluates direct reports.
  • Performs ongoing staff and workflow analysis; establishes plans to ensure adequate staffing.
  • Provides strategic direction and guidance to staff, ensuring responsibilities align with policies.
  • Ensures continuous improvement of knowledge and skill levels for all staff.
• 45% – Financial Support
  • Serves as subject matter expert in producing and maintaining incurred but not reported (IBNR) reserve estimates for all lines of business, providing the Accounting department with needed information for month‑end close.
  • Directs the development of appropriate reimbursement rates and other financial contract provisions between Cal Optima Health and the state of California, including the annual Medi‑Cal rate development template (RDT) and supplemental data/rate requests.
  • Serves as lead authority on provider capitation rate development and pricing adjustments.
  • Directs and supports the team with the semi‑annual Chronic Illness and Disability Payment System (CDPS) risk adjustment process.
  • Develops actuarial studies and related financial operational processes and analytic tools to leverage system automation and enhance accuracy for actuarial analysis.
  • Informs the Executive Director of significant changes or unusual trends in revenue, utilization and costs and proposes recommendations.
• 5% – Other
  • Completes other projects and duties as assigned.

• Bachelor’s degree in finance, math, business, statistics, economics, actuarial services or a related field PLUS 7 years of actuarial or analytics experience within health care required; an equivalent combination of education and experience may also be qualifying.
• 3 years of experience in a finance leadership role responsible for actuarial and/or analytics at a health plan, including direct supervision of staff, required.

• Advanced degree in a related field.
• Tableau or Power BI experience.
• Experience leveraging artificial intelligence or machine learning for predictive analytics model development.
• Fellow of the Society of Actuaries (FSA).

• Associate of the Society of Actuaries (ASA).

• Develop rapport and establish and maintain effective working relationships with leadership, staff and external contacts at all levels.
• Work independently and exercise sound judgment.
• Communicate clearly and concisely, both orally and in writing.
• Work a flexible schedule; available to participate in evening and weekend events.
• Organize, be analytical, problem‑solve and possess project management skills.
• Work in a fast‑paced environment and in an efficient manner.
• Manage multiple projects and identify opportunities for internal and external collaboration.
• Motivate and lead multi‑program teams and external committees/coalitions.
• Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job‑specific applications/systems.

• Ability to visually read information from computer screens, forms and other printed materials.
• Ab…