Senior Director, Individual and Small Employer Pricing job El Segundo California
Senior Director, Individual and Small Employer Pricing job El Segundo California
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Senior Director, Individual and Small Employer Pricing Job

Employer Name: SpiderID: 13196688
Location: El Segundo, California Date Posted: 1/24/2023
Wage: Negotiable Category: Insurance
Job Code: 17002FG-2191

Job Description:
Looking for a chance to do meaningful work that touches millions? Come join the hardest working, nonprofit health plan in California and help us shape the future of health care. Blue Shield of California's Mission is to ensure all Californians have access to high-quality care at an affordable price. Blue Shield is focused on improving health care delivery by working closely with providers and making it more accessible, affordable and customer-centric. Being a mission-driven organization means we do much more than serve our 4 million members: we were the first health plan in the nation to limit our annual net income to 2 percent of revenue and return the difference to our customers and the community, and since 2005 we have contributed more than $325 million to the Blue Shield of California Foundation to improve community health and end domestic violence. We also believe that a healthier California begins with our employees, so we provide them with resources to develop and maintain a healthy lifestyle through our award-winning wellness program, Wellvolution.

We're hiring smart thinkers and doers who want to work for a leader and innovator in the challenging, ever-changing healthcare space. Come and help us make health care better for everyone.


Business Unit: Finance / Actuarial Services, Pricing

The Pricing team within Blue Shield's Actuarial Services department handles pricing for all lines of business within Blue Shield. Pricing actuaries are key partners in strategy, product design, forecasting, budgeting, financial analysis and long term planning.

This position is responsible for pricing, forecasting, and budgeting for Blue Shield's Individual and Small Employer lines of business. Reporting to this position are two actuarial managers for each line of business, with a team of actuarial analysts underneath each manager. We are looking for an actuary that has the drive and ability to be a key partner in Blue Shield's business and strategic decisions. This position requires a solid understanding of the Affordable Care Act and the ability to communicate actuarial analysis and concepts across the organization and up to the highest levels of Blue Shield management.

  • Managing annual pricing process for Blue Shield's Individual lines of business, for both ACA regulated business and Grandfathered business.

  • Managing quarterly pricing process for Blue Shield's Small Employer line of business.

  • Directing and prioritizing the work of both pricing managers.

  • Partnering with each Business Unit General Manager on product design, pricing strategy, and budgeting.

  • Managing the forecasting process and annual planning for both revenue and cost of healthcare.

  • Investigating and explaining monthly financials and variances to forecast for both revenue and cost of healthcare.

  • Working with both state (California Department of Managed Healthcare, California Department of Insurance) and federal (CMS, HHS) regulators regarding required rate filings and objection letters.

  • Meeting and collaborating with our partners in Covered California on pricing, enrollment policies, and benefit design

  • Developing presentation materials for our pricing and forecasting results and explaining them in meetings to Senior Management.


  • A minimum of a Bachelor's degree in Actuarial Science, Statistics, Mathematics, or other relevant field.

  • A minimum of 10 years of health actuarial experience .

  • A minimum of 5 years of experience in either Individual or Small Employer pricing.

  • A minimum of 2 years of experience in ACA-regulated business (Individual or Small Business).

  • Hands on experience in analyzing and understanding the ACA or Medicare risk adjustment models.

  • Experience in submitting and/or managing rate filings for Individual and/or Small Business.

  • A minimum of 2 years managing teams of actuaries (e.g. managing managers).

Preferences :

  • Actuarial experience specific to the California market and the California provider system.

  • Experience in managing and developing monthly forecasts for both revenue and cost of healthcare (rate increases, demographics, trends, buydowns, seasonality, etc.).

  • Deep understanding of the ACA regulations and how they affect Individual and Small Employer pricing.

  • Verbal communication skills and the ability to respond to questions from management in realtime.

  • P owerpoint skills and an understanding of how to craft clear and concise presentations.

Job Criteria:
Start Date:
Position Type: Full-Time Permanent
Years of Experience Required:
Education Required:
Overnight Travel:
Vacation Time:

Contact Information:
Contact Name: Blue Shield of California Company Type:
Company: Blue Shield of California

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