Actuarial Analyst, Senior

Blue Shield of California - Rancho Cordova, CA

Full-time - Mid Level

Rancho Cordova, CA

Insurance Carriers and Related Activities

About the position

The Senior Actuarial Analyst at Blue Shield of California plays a crucial role in the Network and Provider Analytics team, focusing on financial analyses and modeling to support provider contracting for CalPERS. This position involves utilizing data analytics to assess risks, develop pricing strategies, and evaluate provider reimbursement terms, ensuring the development of an affordable provider network.

Responsibilities

• 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 evaluate 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 statistical programming languages (including R, Python, SQL, SAS) and deploy predictive analytics and machine learning techniques to improve risk prediction, reserve, trend and financial forecasting.
• 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 of 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.

Requirements

• Bachelor's degree with at least a minor in mathematics, statistics, computer science or equivalent business experience.
• Minimum of 3 years of professional actuarial experience.
• 2 years of experience in Health Care (managed care, academic, or government payer).
• Experience analyzing healthcare claims data, trends, and forecasting.
• Proficiency in Excel and comfort working with large data sets.
• Knowledge of SAS is preferred.

Benefits

• Competitive salary based on experience and location.
• Comprehensive health insurance coverage.
• Retirement savings plan options.
• Opportunities for professional development and training.