Actuarial Manager

Join Us in this Amazing Opportunity

The Team You’ll Join

We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all.

More About the Opportunity

We are hoping you will join us as a Manager Actuary and help shape the future of healthcare where you’ll be an integral part of our Financial Analysis team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. This position has been approved to be Partial Telework.

• If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum.

The Manager Actuary is a key member of the Financial Analysis team and will be responsible for leading the development and communication of financial analyses and metrics to senior leadership to ensure the fiscal integrity of CalOptima Health’s program and policy decisions. You will oversee all reserving and incurred but not reported (IBNR) related activities and complete annual rate and regulatory filings. You will also support the completion of Medicare bids and the development of capitation models and associated risk adjustment methodologies. Additionally, you will provide actuarial expertise to advance strategic initiatives, supervise staff, providing direction, monitoring performance and ensuring compliance with organizational standards. Together, we are building a stronger, more equitable health system.

Your Contributions To the Team:

• 50% - Supervisory Functions
• Cultivates and promotes 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 the leadership team and staff to support short- and long-term goals/priorities for the department.
• Advises management of significant changes or unusual trends in revenue, utilization and costs.
• Leads the development of appropriate reimbursement rates and other financial contract provisions between CalOptima Health and the state of California, including completion of the annual Medi-Cal Rate Development Template and all supplemental data/rate requests as required by the state.
• Hires, supervises, develops, counsels and reviews the performance of department staff.
• Provides direction and guidance to actuarial staff, ensuring work aligns with established departmental and organizational policies.
• 40% - Actuarial Functions
• Produces and maintains IBNR reserve estimates for all lines of business to provide the Accounting department with needed information for the month-end close.
• Supports provider capitation rate development and pricing adjustments as appropriate.
• Manages semi-annual Chronic Illness and Disability Payment System (CDPS) risk adjustment process.
• Leads the completion of annual bid filings for CalOptima Health’s Medicare Advantage plans.
• Participates and assists in financial and regulatory audits as necessary.
• Develops/refines actuarial studies and related financial operational processes and analytic tools to leverage system automation and enhance accuracy for actuarial analysis.
• Supports the development of the annual operating budget by providing detailed analysis of medical utilization and unit cost trends across various population groups and categories of service.
• 10% - Other
• Completes other projects and duties as assigned.

Do You Have What the Role Requires?

• Bachelor’s degree in actuarial science, mathematics, economics, finance or related field PLUS 5 years of actuarial experience required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
• 2 years of Medi-Cal experience required.
• Experience leading programs and projects for a team required.

You’ll Stand Out More If You Possess the Following:

• Master’s degree in actuarial science, mathematics, economics, finance or related field.
• 3 years of progressive leadership experience, including direct supervision of staff.
• Fellow of the Society of Actuaries (FSA).
• Experience with annual Medi-Cal Rate Development Template.
• Experience leveraging AI/ML for predictive analytics model development.
• Tableau or Power BI experience.
• MS SQL, Excel VBA and Power Query experience.

What the Regulatory Agencies Need You to Possess?

• Associate of Society of Actuaries (ASA).

Your Knowledge & Abilities to Bring to this Role:

• Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.
• 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 to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.

Your Physical Requirements (With or Without Accommodations):

• Ability to visually read information from computer screens, forms and other printed materials and information.
• Ability to speak (enunciate) clearly in conversation and general communication.
• Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.
• Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.
• Lifting and moving objects, patients and/or equipment 10 to 25 pounds

Ways We Are Here For You

• You’ll enjoy competitive compensation for this role.
• Our current hiring range is: Pay Grade: 318 - $146,266 - $234,026 ($70.32 - $112.5125).
• The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role and internal equity among other factors.
• This position is approved for Partial Telework (**If the position is Telework, it is eligible in California only**)

*This position will be from 7:30 am to 4:00 pm daily, with in-office attendance required three (3) days a week on Tuesdays, Wednesdays, and Thursdays.

**The first week of every month the position will be in the office Monday - Friday from 7:30 am to 4:00 pm daily.

• A comprehensive benefits package
• CalPERS pension program and additional retirement packages.
• Additional benefits and perks including:
• A generous PTO program
• A quality work life balance
• Various wellness programs
• Tuition Reimbursement
• Professional development opportunities
• Career development opportunities
• Flexible scheduling
• And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families.

Our Work Environment:

If located at the 500, 505 Building or a remote work location:

• Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
• There are no harmful environmental conditions present for this job.
• The noise level in this work environment is usually moderate.

If located at PACE:

• Work is typically indoors in a clinical setting serving the frail and elderly.
• There may be harmful or hazardous environmental conditions present for this job.
• The noise level in this work environment is usually moderate to loud.

If located in the Community:

• Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
• Employee will occasionally work outdoors in varied temperatures.
• There may be harmful or hazardous environmental conditions present for this job.
• The noise level in this work environment is usually moderate to loud.

Why Join Us?

We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and we are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impacts on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare.

What's Your Next Step?

All Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. Do NOT miss out. If you want to join our team, the deadline for the first review of applications is April 28, 2026 at 9:00 PM (PST). We are encouraging you to apply early. If you apply after the first review date, your application is not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date.