Job Description

Your Role

The Actuarial Provider Strategies (APS) team supports the program design, budget setting, and operations of Blue Shield of California’s value-based care (VBC) payment models, which includes Accountable Care Organization (ACO) and other innovative, alternative payment models. The Actuarial Analyst, Senior will report to the Senior Manager of Actuarial Provider Strategies ACO team. In this role you will be supporting analytical work for the Accountable Care Organization (ACO) incentive program and other innovative, alternative payment models, alongside colleagues from a variety of 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 complex analysis, assess risk and population risk scores and assignment, 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 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, and related 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
• Provide financial impacts to key business partners to support decision making on network composition and contracting terms
• Support ACO incentive program analytical work, such as target setting, reconciliation, supporting provider inquiries, and “what-if” modeling for strategy development
• Work cross functionally to respond to provider inquiries while connecting to larger enterprise strategies and needs, including analytics to address the questions.
• Understand how other network initiatives and alternate payment models interplay and affect ACO programs and relationships.
• Work with other colleagues from different areas to solution for the business problems; this may involve presenting either verbally or in written format to key stakeholders or leadership

Your Knowledge and Experience

• Requires a bachelor’s degree with at least a minor in mathematics, statistics, computer science or equivalent business experience
• Requires advanced knowledge of job area obtained through professional experience and advanced education
• Requires at least 3 years of professional actuarial experience
• Requires an ASA or that one has majority of the courses completed for their ASA
• Requires advanced experience and skillset in Microsoft Excel and/or SAS/SQL
• Requires strong communication and presentation skills
• Requires a curious mindset and eagerness to learn
• Requires experience in Visualization tools such as Power BI and/or Tableau
• Prior healthcare industry experience preferred

Pay Range:

The pay range for this role is: $ 99000.00 to $ 148500.00 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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