Job Description

Your Role

The Network and Trend Analytics team drives the development of an affordable provider network through data analytics and expertise. The Actuarial Analyst, Consultant will report to the Senior Manager. In this role, you will lead and perform financial analyses and modeling for provider contracting support including term changes, renewals, network changes, and terminations for physician groups, hospitals, ambulatory surgery centers, and other types of providers

Your Work

In this role, you will:

• Understand the core principles and functionality of decision, descriptive, predictive, and prescriptive analytic methods including forecasting and statistical techniques
• Conduct and develop analysis, assess risk and population risk scores and assignment, develop trends, 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 a combination of statistical programming languages (including, but not limited to, SQL and SAS) and proactively deploy analytic techniques to improve trend and financial forecasting in a manner that is actuarially sound, and enable real-time results and operational efficiencies
• Direct, coordinate, and/or develop evaluation and financial reporting standards for internal and external reports

• Create financial unit cost trend reporting and rate calculations under limited oversight using Excel and other 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 complex contract rate proposals from physician groups, hospitals, ambulatory surgery centers, and other providers to assess the financial and trend impact

• Provide consultation and partner with network management department in maintaining and developing the provider network and contracting strategy
• Provide leadership, coaching, and training to other analysts

Your Knowledge and Experience

• Requires a bachelor’s degree with at least a minor in mathematics, statistics, computer science or equivalent business experience

• Requires at least 6 years of professional actuarial experience

• Typically has obtained their ASA designation and has completed 1 to 2 courses toward their FSA designation

• Requires at least 5 years of experience in analyzing healthcare claims data, trends, and forecasting in a managed care setting

• Requires critical thinking and analytical abilities, including interpreting business requirements and developing analytical methods

• Requires proficiency in Excel and comfort working with large data sets

• Requires current working knowledge of SQL and/or SAS

• Experience with financial analysis of provider contracts and common reimbursement methodologies is preferred
  

Hybrid

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.

Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.

ABOUT THE TEAM
About Blue Shield of California

As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.

At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.

Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities – join us!

Our Values:

• Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
• Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
• Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

Our Workplace Model

We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:

• For most teams, this means coming into the office two days per week.

• Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.

• For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.

The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.

Physical Requirements:

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Equal Employment Opportunity:

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.

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