Actuarial Jobs in Berkeley, CA

SVP, Kaiser Permanente Health Plan - CA Market

The Senior Vice President, Kaiser Permanente Health Plan (SVP, KPHP) is a collaborative, strategic leader responsible for the overall health plan performance, growth, and profitability across all product lines within their market(s). This role requires strong communication, adaptability, and the ability to build consensus in a complex, matrixed environment. The SVP partners closely with Regional Presidents (RP), Executive Medical Directors (EMDs), and national function leaders to drive membership growth, revenue, and margin sustainability.

Key responsibilities encompass overseeing line of business performance specifically for membership growth, mix, and rate setting, underwriting, health plan operations, and customer and broker relationships. The leader is also responsible for the evaluation of trend and trend drivers for both customer rate rationalization and affordability management. The role works directly with various teams to provide and support network management, contracting, operational setup, billing, and payment integrity, as well as other essential health plan services. This involves collaborating with leaders at national, regional, and care delivery levels to ensure outstanding value and quality for both members and customers.

The SVP of KPHP will collaborate with the Regional President and EMDs to evaluate strategic health plan line of business membership opportunities and challenges, and to create and implement subsequent business plans. Further, the position is responsible for the development and execution of health plan strategies to ensure they are coordinated across different regions, business areas, and products, supporting key performance goals. Duties include anticipating changes in policy, using market insights and data, and assessing membership trends to spot and pursue growth prospects. The SVP will turn these findings into practical strategies that drive improvement in health plan performance.

The SVP, KPHP, Regional Presidents, and EMDs for each market operate together as a unified team. The organizations success depends on cross-functional collaboration and shared accountability. Integrated leadership is the strength of Kaiser Permanentes model that drives distinctive quality and affordability. The SVP aligns efforts through regular, structured collaboration to ensure clarity, consistency, and progress toward shared goals. Each leader is responsible for driving performance in their respective domain, delivering key metrics, actions, and updates, while working together on the collective vision for the market.

The SVP is responsible for the markets health plan success, contributing to profit and loss results and ensuring financial performance aligns with budget and long-term plans. This leader anticipates market changes, leverages data and insights, works with key leaders across the organization to ensure regulatory compliance and to enhance the member experience. Success in this role depends on effective collaboration, shared accountability, and commitment to Kaiser Permanentes mission of integrated, value-based care.

Essential Responsibilities:

• Partnership with Regional President(s) and Executive Medical Director(s): Collaborate with regional president(s) and Executive Medical Director(s) to align and lead operations and initiatives to achieve market leading growth and total margin.
• Strategic Planning & Alignment: Partner with Regional Presidents (RP) and Executive Medical Directors (EMDs) to define health plan strategic priorities by defining revenue sufficiency, target markets, products, and capital needs. Completes competitive intelligence and market SWOT development and product market fit to ensure strategies are aligned across geographies, business lines, and products.
• Performance & Growth Management: Drive financial and health plan operational success by partnering with regional leaders, supporting sustainable health plan revenue growth, profitability, and market competitiveness across all product lines.
• Rate Setting & Underwriting: Partners with RP to lead rate setting and partners with underwriting and actuarial teams to ensure competitive pricing, revenue sufficiency, and regulatory compliance.
• Network Management: Collaborate with national function leaders and regional president to design, build, and maintain provider networks that support high-quality, cost-effective care and member satisfaction.
• Medical Cost Trend Management: Partner with the national function leaders and regional president and seek consultation of EMD to support analytic and contracting strategies to control medical cost trends while maintaining quality of care and member satisfaction.
• Drive local market accurate and comprehensive diagnostic coding: Collaborate with national function leaders, Care Delivery Operations, regional president and EMDs to provide complete diagnostic coding for all risk-adjustable business lines, including individual, small business, Medicare, and Medicaid.
• Customer & Broker Relationships: Foster strong relationships to improve retention, satisfaction, and market presence.
• Go-to-Market & Sales Leadership: Partner with marketing and sales teams to develop and execute local market strategies for brand awareness, member acquisition, and retention.
• Line of Business Leadership: Partner with RP and EMD, with direct responsibility for contributing to line of business P&L results, focusing on margin targets through growth, revenue optimization, effective management, and risk mix. Oversees health plan administrative costs and works with national leadership to maintain the right mix of business and revenue within local markets.
• Commercial Lines of Business
• Drive financial and operational performance across commercial product lines, including individual.
• Set competitive rates and benefits to support growth and market needs.
• Partners to ensure network adequacy, compliance, and member satisfaction.
• Partner to support affordability action plans and analyze medical spending.
• Medicare Line of Business
• Optimize benefits and bids to maximize competitiveness.
• Maintain compliance with CMS regulations and drive quality ratings.
• Improve risk adjustment accuracy
• Partner to ensure effective population health programs and support affordability action plans
• Works with key leaders to support the success of the Medicare Stars program, inclusive of action plans aimed at achieving high MCAHPS and NPS.
• Medicaid Line of Business
• Partner to ensure effective population health programs and support affordability action plans
• Partners to ensure compliance with CMS and state regulations.
• Partner for network adequacy and member satisfaction through collaborative action plans aimed at achieving high CAHPS and NPS
• Regulatory & Compliance Oversight: Partner with national function leaders to ensure compliance with all federal and state regulations across product lines, including Medicare Advantage, Medicaid, and ACA marketplaces.
• Team Leadership: Lead and mentor a cross-functional matrixed team across business management, network, underwriting, actuarial, and government affairs functions. Build a high performing, engaged workforce aligned with KPs mission and objectives.
• Measurement & Accountability: Partner with national function leaders to implement measurement systems and operating models to track growth and margin performance, aligned with enterprise and health plan priorities.

Basic Qualifications: Experience

• Minimum fifteen (15) years of progressive leadership experience in the healthcare industry, with at least seven (7) years in a senior executive role within a health plan or payer organization.

Education

• Bachelors degree in business administration, Healthcare Administration, or a related field required.

License, Certification, Registration

• N/A

Additional Requirements:

• Proven track record of driving revenue growth, managing P&L, and achieving financial targets in a complex, multi-product health plan environment.
• Extensive experience with Medicare Advantage, Medicaid, and commercial product lines (individual, small business, midsized, large group, and national accounts).
• Demonstrated success in network management, medical cost containment, and go-to-market strategies.
• Strategic vision with the ability to translate goals into actionable plans.
• Strong financial acumen, with expertise in underwriting, actuarial analysis, and P&L management.
• Exceptional leadership and team-building skills, with a focus on collaboration and mentorship.
• Outstanding communication and relationship-building abilities to engage with customers, brokers, providers, and regulators.
• Deep understanding of healthcare regulations, including ACA, Medicare, and Medicaid requirements.
• Proven ability to influence a complex organization to ensure that performance standards are customer-driven.
• Excellent creative and analytical problem-solving skills. Ability to credibly influence decision makers to act on fact-based recommendations.
• Strong entrepreneurial style and customer focus.
• Proven leadership in driving flawless administrative and internal functions in support of the customer.
• Prior experience working in a complex payer organization, possessing facilitation, negotiation, and consensus building skills. The ability to set clear and challenging goals while committing the organization to improved performance; tenacious and accountable in driving results.
• Comfortable with ambiguity and uncertainty; the ability to adapt nimbly and lead others through complex situations.
• A risk-taker who seeks data and input from others to foresee possible threats or unintended circumstances from decisions; someone who takes smart risks.
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