Actuarial Analyst, Senior

Blue Shield of California - San Diego, CA

Full-time - Mid Level

San Diego, 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 advanced analytical methods to assess risks, develop pricing strategies, and improve operational efficiencies within the provider network.

Responsibilities

• Understand 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, develop pricing and trends, and analyze provider reimbursement terms.
• Coordinate, prepare, perform, and audit actuarial analyses to assist in the development of complex actuarial formulations.
• Perform data exploration using statistical programming languages (R, Python, SQL, SAS) and deploy predictive analytics to improve risk prediction and financial forecasting.
• Develop evaluation and financial reporting standards for internal and external reports.
• Conduct independent analysis of high complexity under moderate supervision and develop novel analyses and reports.
• Create financial unit cost trend reporting and rate calculations using Excel modeling tools.
• Run and maintain SAS queries to gather data for complex financial analysis.
• Reprice historical data against provider contract terms based on understanding of contract structure.
• Analyze CalPERS PPO contract rate proposals to assess financial and trend impact.
• Partner with network management to maintain and develop 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.