Job Description

Your Role

The Network and Provider Analytics team drives the development of an affordable provider network through data analytics and expertise. The Senior Actuarial Analyst will report to the Senior Manager. In this role you will perform financial analyses and modeling for CalPERS provider contracting support including term changes, renewals, network changes, and terminations for 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 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 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

• 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 on 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

Your Knowledge and Experience

• Requires a bachelor’s degree with at least a minor in mathematics, statistics, computer science or equivalent business experience
• Requires a minimum of 3 years of professional actuarial experience
• Requires 2 years of experience in Health Care (managed care, academic, or government payer)
• Requires eperience analyzing healthcare claims data, trends, and forecasting
• Requires proficiency in Exce and comfort working with large data sets
• Knowledge of SAS is preferred

Pay Range:

The pay range for this role is: $ 99000.00 to $ 148500.00 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.

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