Your Role
The Network and Provider Analytics team drives the development of an affordable provider network through data analytics and expertise. The Senior Actuarial Analyst will report to the Senior Manager. In this role you will perform financial analyses and modeling for CalPERS provider contracting support including term changes, renewals, network changes, and terminations for hospitals, ambulatory surgery centers and other types of providers.
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
- Conduct independent analysis of high complexity under moderate supervision and guidance, develop novel analyses and reports
- Develop documentation and create and execute workplans for analyses of high complexity
- Create financial unit cost trend reporting and rate calculations under moderate supervision using Excel modeling tools
- Run and maintain SAS queries to gather data required for complex financial analysis
- Reprice historical data against provider contract terms based on deep understanding on contract structure and configuration
- Analyze CalPERS PPO contract rate proposals from hospitals and ambulatory surgery centers to assess the financial and trend impact
- Partner with network management department in maintaining and developing the CalPERS PPO provider network and contracting strategy
Qualifications
Your Knowledge and Experience
- Requires a bachelor's degree with at least a minor in mathematics, statistics, computer science or equivalent business experience
- Requires a minimum of 3 years of professional actuarial experience
- Requires 2 years of experience in Health Care (managed care, academic, or government payer)
- Requires eperience analyzing healthcare claims data, trends, and forecasting
- Requires proficiency in Exce and comfort working with large data sets
- Knowledge of SAS is 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.
About the Team
Blue Shield of California's mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our continued commitment to diversity, equity, and inclusion upholds our values and advances our goal of creating a healthcare system that is worthy of our family and friends while addressing health disparities, promoting social justice, and integrating health equity through our products, business practices, and presence as a corporate citizen.
Blue Shield has received awards and recognition for being a certified Fortune 100 Best Companies to Work, Military Friendly Employer, People Companies that Care, a Leading Disability Employer, and one of California's top companies in volunteering and giving. Here at Blue Shield, we strive to make a positive change across our industry and communities - join us!
Our Values:
- Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
- Human. We strive to be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes.
- Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.
Our Workplace Model:
At Blue Shield of California, we believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility. As we continue to evolve our workplace model, our focus remains on creating spaces where our people can connect with purpose - whether working in the office or through a hybrid approach - by providing clear expectations while respecting the diverse needs of our workforce.
Two Ways of Working:
- Hybrid (Default): Work from a business unit-approved office at least two (2) times per month (for roles below Director-level) or once per week (for Director-level roles and above).Exceptions:
- Member-facing and approved out-of-state roles remain remote.
- Employees living more than 50 miles from their assigned offices are expected to work with their managers on a plan for periodic office visits.
- For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.
- On-Site: Work from a business unit-approved office an average of four (4) or more days a week.
Physical Requirements:
Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.
Please click here for further physical requirement detail.
Equal Employment Opportunity:
External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.