Blue Shield of California
Actuarial Analyst, Senior
Blue Shield of California, Oakland, California, United States, 94616
Your Role
The Blue Shield’s Risk Adjustment (RA) Chart Review and Analytics team plays a crucial role in bringing healthcare into the digital age. The RA team is highly cross-functional, with each team member deeply skilled in both business-operations and data-analytics; this enables us to deliver industry-leading results. The Actuarial Analyst, Senior will report to the Manager and Actuary of Risk Adjustment Analytics. In this role you will enhance Blue Shield’s data-driven decision-making by refining chart targeting logic, optimizing ROI reporting processes, and deliver insightful ad-hoc analytics to support retrieval strategic initiatives.
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
Advise on improvements on Blue Shield's Digital Health Record Strategies
Create data-driven solutions for capturing risk and improving quality of care for our members
Participates in the development of risk adjustment operational and strategic planning processes
Provide expert knowledge and insights in the CMS HCC Risk Adjustment modeling
Perform other responsibilities as assigned
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 3 years of professional actuarial experience
Requires an ASA or that one has majority of the courses completed for their ASA
Requires advance knowledge of job area obtained through professional expereince and advanced education
Requires ability to program in SQL, SAS and/or Tableau, and experience with common data science toolkits
as R and Python
Requires one to be an independent, proactive problem solver with patience for working on large scale problems
Requires proficiency with Microsoft Excel
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
The Blue Shield’s Risk Adjustment (RA) Chart Review and Analytics team plays a crucial role in bringing healthcare into the digital age. The RA team is highly cross-functional, with each team member deeply skilled in both business-operations and data-analytics; this enables us to deliver industry-leading results. The Actuarial Analyst, Senior will report to the Manager and Actuary of Risk Adjustment Analytics. In this role you will enhance Blue Shield’s data-driven decision-making by refining chart targeting logic, optimizing ROI reporting processes, and deliver insightful ad-hoc analytics to support retrieval strategic initiatives.
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
Advise on improvements on Blue Shield's Digital Health Record Strategies
Create data-driven solutions for capturing risk and improving quality of care for our members
Participates in the development of risk adjustment operational and strategic planning processes
Provide expert knowledge and insights in the CMS HCC Risk Adjustment modeling
Perform other responsibilities as assigned
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 3 years of professional actuarial experience
Requires an ASA or that one has majority of the courses completed for their ASA
Requires advance knowledge of job area obtained through professional expereince and advanced education
Requires ability to program in SQL, SAS and/or Tableau, and experience with common data science toolkits
as R and Python
Requires one to be an independent, proactive problem solver with patience for working on large scale problems
Requires proficiency with Microsoft Excel
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