Your Role

The Actuarial Provider Strategies team support the design and analytical operations of Blue Shield of California's value-based care strategy. The Actuarial Analyst, Principal will report to the Senior Director of Actuarial Provider Strategies. In this role you will have responsibility managing the ACO relationship, which will involve leading analysts to support analytics work, such as target setting, reconciliation, supporting provider inquiries, and "what-if" modeling for strategy development.

Your Work

In this role, you will:

• Understand the core principles and functionality underlying decision, descriptive, predictive, and prescriptive advanced analytic methods
• 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 evaluates 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 a combination of statistical programming languages (including, but not limited R, Python, SQL, SAS) and deploys predictive analytics and machine learning techniques to improve risk prediction, improve reserve, trend and financial forecasting in a manner that is actuarially sound, and enable real-time results and operational efficiencies
• Lead, coordinate and/or develop strategic, market and competitive analysis
• Have overall responsibility and accountability for leading and managing analytics work products related to target setting, reconciliation, and reporting (internal and/or external) for the responsible ACO programs
• Be responsible for establishing and maintaining relationships with internal stakeholders and external providers in addition to direct provider communications
• Work cross functionally to respond to provider inquiries while connecting to larger enterprise strategies and needs, including leading analytics with supporting staff to address the questions. Understand how other network initiatives and alternative payment models interplay and affect the ACO programs and relationship
• Ensure team follows existing work-flow procedures or policies and/or validates or develops new procedures and policies
• Lead and/or support other general program operations work, ranging from savings projection, accrual setting, addressing data issues and developing solutions, executing program renewals/conversions, iterative model design changes, improving and streamlining operations efficiency

Your Knowledge and Experience

• Requires a bachelor's degree in mathematics, statistics, computer science or equivalent business experience
• Requires an ASA
• Requires at least 8 years of professional actuarial experience
• Prior experience related to value-based care or provider analytics preferable
• Strong ability to communicate complex technical subjects to non-technical audiences
• Strong project management skills
• Strong problem-solving skills, self-motivation, detail orientation and critical thinking skills

Pay Range:

The pay range for this role is: $ 145200.00 to $ 217800.00 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.