Actuarial Analyst, Senior

Blue Shield of California - El Dorado Hills, CA

Full-time - Mid Level

El Dorado Hills, CA

Insurance Carriers and Related Activities

About the position

The Senior Actuarial Analyst position at Blue Shield of California involves performing financial analyses and modeling to support provider contracting for CalPERS. This role focuses on understanding and applying various analytic methods to assess risk, develop pricing strategies, and evaluate provider reimbursement terms, all aimed at enhancing the affordability and efficiency of the provider network.

Responsibilities

• Understand core principles of decision, descriptive, and predictive analytic methods including forecasting and statistical techniques.
• Conduct and develop analyses to assess risk and population risk scores, develop pricing and trends, and analyze changes in benefit designs.
• Coordinate, prepare, perform, and audit actuarial analyses to assist in developing 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 contract structure and configuration.
• 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.