Job Description

Your Role

The Blue Shield’s Risk Adjustment (RA) Chart Review and Analytics team plays a crucial role in bringing healthcare into the digital age. The RA team is highly cross-functional, with each team member deeply skilled in both business-operations and data-analytics; this enables us to deliver industry-leading results. The Actuarial Analyst, Senior will report to the Manager and Actuary of Risk Adjustment Analytics. In this role you will enhance Blue Shield’s data-driven decision-making by refining chart targeting logic, optimizing ROI reporting processes, and deliver insightful ad-hoc analytics to support retrieval strategic initiatives.

Your Work

In this role, you will:

• Understand the core principles and functionality of decision, descriptive and predictive 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 deploys 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 
• Develop evaluation and financial reporting standards for internal and external reports
• Advise on improvements on Blue Shield's Digital Health Record Strategies
• Create data-driven solutions for capturing risk and improving quality of care for our members
• Participates in the development of risk adjustment operational and strategic planning processes
• Provide expert knowledge and insights in the CMS HCC Risk Adjustment modeling
• Perform other responsibilities as assigned

Your Knowledge and Experience

• Requires a bachelor’s degree with at least a minor in mathematics, statistics, computer science or equivalent business experience
• 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 advance knowledge of job area obtained through professional expereince and advanced education
• Requires ability to program in SQL, SAS and/or Tableau, and experience with common data science toolkits as R and Python
• Requires one to be an independent, proactive problem solver with patience for working on large scale problems
• Requires proficiency with Microsoft Excel

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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