Your Role
The Sr. Principal Actuarial Analyst for our Medi-Cal team is responsible for overseeing rate development & rate analysis, Medi-Cal program analysis, experience reporting, and Medi-Cal program strategy. This position requires directly managing 1 actuarial analyst and partnering with Senior Leadership and cross-functional teams to drive successful strategy and analytics. This role will report directly to the Senior Director of Medicare Finance & CFO Promise Health Plan. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.
Your Work
In this role, you will:
- Rate Development/Analysis; Influence & Negotiation
- Be responsible for developing, updating, and evaluating all rate packages from DHCS including development factors, trend support, actuarial assumptions, program analysis, and risks or opportunities
- Report to the CFO of Promise Health Plan and senior executives of Promise Health Plan financial opportunities and areas of focus for performance optimization
- Assist with, and influence, rate negotiation and rate guidance
- Revenue & Cost of Healthcare Forecasting for Medi-Cal / Promise Health Plan
- Develop, implement, manage and own advanced analytics projects from end to end and proactively add improvements and enhancements
- Explain and influence the project to audiences outside the job function and to senior leaders. Will drive and ensure alignment of project with team goals and long-term strategic goals
- 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 evaluate actuarial risk related analysis
- Medi-Cal Program Actuarial Support & Revenue optimization
- Financial and Actuarial Process support and Talent development
- Medi-Cal strategy development & program planning
- Acts as the lead subject matter expert in the data areas of claim, premium, membership, and/or risk score assignment
- Work closely with Senior Leadership at Promise Health Plan to understand strategic direction and financial strengths and opportunities
- Partner with financial and actuarial leaders to strengthen finance and actuarial processes and build strong talent pipelines
- Partner with CFO of Promise Health Plan on annual budget setting process and on-going forecasting processes
- Responsible for evaluating and explaining monthly financial variances to plan for revenue and cost of healthcare
- Understand the core principles and act as an expert within a specialized discipline, along with the functionality underlying decision, descriptive, predictive and prescriptive advanced analytic methods
Qualifications
Your Knowledge and Experience
- Requires college degree in mathematics, statistics, computer science or equivalent business experience
- Requires 8 years of professional health actuarial experience.
- Requires a minimum of 5 years of experience in health actuarial pricing
- Requires an ASA, may have FSA designation, must be working towards FSA if not complete
- Requires extensive knowledge of job area (including health plan operations) and regulations obtained through professional experience and advanced education.
- Requires a mastery level knowledge within the Actuarial job area and may have deeper knowledge of project management.
- Requires a high proficiency in applied statistics skills, such as distributions, statistical testing, and regression
- Requires the ability to program in SQL, SAS and/or Tableau, and experience with common data science toolkits such as R and Python
- Requires a business level, functional exposure to three or more machine learning algorithms such as random forest, decision trees, clustering, generalized linear models, principle component analysis
Pay Range:
The pay range for this role is: $ 172260.00 to $ 258280.00 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.