Job Description

Your Role

The Actuarial Provider Strategies team helps design and implement value-based care (VBC) payment models, which include Accountable Care Organizations (ACOs) and other innovative alternative payment models (APMs) to improve the affordability and quality of care our members receive. The Experienced Actuarial Analyst will report to the Senior Manager of Actuarial Provider Strategies and work closely with their team and with colleagues from various backgrounds and roles within the company.

Your Work

In this role, you will:

• Understand the core principles and functionality of decision, descriptive, predictive and prescriptive analytic methods including forecasting, statistical and machine learning techniques
• Conduct and develop analysis, assess risk and population risk scores and assignment, develop pricing and trends, assess changes in benefit designs, develop reserves, perform forecasting, analyze provider reimbursement terms and/or evaluates actuarial risk related analysis
• Coordinate, prepare, perform and audit actuarial analyses to assist in the development of complex actuarial formulations leading to the recommendation of pricing, trending, reserving, provider reimbursement and/or risk assessment strategies
• Perform data exploration using a combination of statistical programming languages (including, but not limited R, Python, SQL, SAS) and deploy predictive analytics and machine learning techniques to improve risk prediction, improve reserve, trend and financial forecasting in a manner that is actuarially sound, and enable real-time results and operational efficiencies
• Direct, coordinate, and/or develop evaluation and financial reporting standards for internal and external reports
• Support the creation of innovative value-based care (VBC) designs and strategies
• Provide financial modeling, forecasting, and analytical support for VBC programs
• Support the development of dashboards, scorecards, and other reporting tools using data visualization tools such as Excel, Tableau, and/or Power BI
• Research clinical and financial outcomes from other VBC programs in the healthcare industry
• Present financial materials to key stakeholders and leadership such as Network, Payment Innovation, Clinical and Actuarial partners

• Requires a bachelor’s degree with at least a minor in mathematics, statistics, computer science or equivalent business experience
• Requires at least 2 years of professional actuarial experience
• Requires prior healthcare industry experience
• Requires advanced experience in Microsoft Excel and SAS/SQL
• Requires strong communication, presentation, and creative problem-solving skills
• Requires proficiency in data visualization tools such as Tableau and/or Power BI preferred
• Requires excellent organizational and project management skills

Pay Range:

The pay range for this role is: $ 79750.00 to $ 111650.00 for California.

Note:

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.

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