Actuarial Analyst, Senior

Your Role

Join the Actuarial Pay for Value team and help Blue Shield lead the industry in value-based care innovation, setting the standard for how care is paid for. Reporting to the Senior Manager, Actuarial Pay for Value, you will develop the strategies and financial models behind our value-based payment programs, including hospital value models, episode-based specialty care models, and vendor partnerships across a wide range of clinical areas such as orthopedics, maternity, oncology, and behavioral health.

Engaged from strategy and design through contracting, implementation, and ongoing operations, you will partner with clinical, network, finance, and operations leaders to turn complex data into actionable recommendations. In this highly visible role, you will work directly with senior leaders to build solutions that advance affordability and quality for Californians.

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 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 SQL, Python, R) 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

Design innovative value-based payment strategies and arrangements, including hospital value models, shared savings, episode-based models, and global budgets, from concept through contracting

Build financial models and forecasts that quantify cost, savings, and risk to guide contract terms, pricing, and investment decisions

Evaluate specialty vendor and clinical program performance, including fee structures, ROI, engagement, and performance guarantees, and recommend whether to expand, renegotiate, or discontinue

Support implementation and ongoing operations, including attribution, payment and reconciliation methodologies, and performance reporting

Use AI-enabled tools and automation to streamline analytics, accelerate insights, and improve reporting efficiency

Present insights and recommendations to senior leaders and partner with them to shape provider payment strategy

Lead analytical workstreams end to end with minimal supervision and mentor junior actuarial staff

Your Knowledge and Experience

• Requires a bachelor’s degree in mathematics, statistics, actuarial science, computer science, or a related field
• Requires 5 years of prior relevant experience delivering pricing, reserving, forecasting, or risk analytics
• Requires hands-on experience working with medical and pharmacy claims, eligibility, and provider reimbursement data
• Requires advanced proficiency in Excel and SQL or a comparable language such as Python or R; experience with cloud-based data platforms such as Databricks or Microsoft Fabric preferred
• Requires strong communication, problem-solving, and project management skills, with the ability to present complex analyses clearly to leadership
• Preferred: Experience developing dashboards, data models, or reporting solutions using tools such as Power BI or Tableau
• Preferred: Experience with value-based care, provider contracting, alternative payment models, or vendor/program evaluation
• Preferred: Attained ASA, Associate of the Society of Actuaries
• Preferred: Attained FSA, Fellow of the Society of Actuaries

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.