California Physicians' Service - Oakland, CA
posted 2 months ago
In this role, you will be responsible for converting pricing and financial goals at the line of business and region level into specific action plans at the provider level that the Network team can execute. This involves creating value for the Growth team General Managers by ensuring they have a voice when it comes to key network decisions and network strategy. You will also create value for the Network team by organizing and focusing the various requests from the General Managers and Pricing Team into a prioritized, workable list. Strong influencing skills across multiple functions within Blue Shield are essential, along with a drive towards consensus and the ability to handle shifting priorities and ambiguity with agility. Additionally, you will lead, coordinate, and/or develop strategic, market, and competitive analysis. This includes conducting and developing analysis, assessing risk and population risk scores and assignments, developing pricing and trends, assessing changes in benefit designs, developing reserves, performing forecasting, analyzing provider reimbursement terms, and evaluating actuarial risk-related analysis. You will also 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.