Blue Shield of California
Actuarial Analyst, Consultant
Blue Shield of California, California, Missouri, United States, 65018
Actuarial Analyst, Consultant
Blue Shield of California
About the Team 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.
Responsibilities
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.
Qualifications
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.
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.
About Blue Shield of California Blue Shield of California is a subsidiary of Ascendiun, a nonprofit corporate entity that includes Blue Shield of California, Blue Shield of California Promise Health Plan, Altais, and Stellarus. The organization’s mission is to create a healthcare system worthy of our family and friends and sustainably affordable. Blue Shield of California is recognized as a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace.
Physical Requirements Office Environment – roles involving part to full time schedule in Office Environment. Activity level: Sedentary, frequent most of work day. Please click here for further physical requirement detail.
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 regard 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.
Seniority Level Mid‑Senior level
Employment Type Full‑time
Job Function Finance and Sales
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About the Team 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.
Responsibilities
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.
Qualifications
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.
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.
About Blue Shield of California Blue Shield of California is a subsidiary of Ascendiun, a nonprofit corporate entity that includes Blue Shield of California, Blue Shield of California Promise Health Plan, Altais, and Stellarus. The organization’s mission is to create a healthcare system worthy of our family and friends and sustainably affordable. Blue Shield of California is recognized as a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace.
Physical Requirements Office Environment – roles involving part to full time schedule in Office Environment. Activity level: Sedentary, frequent most of work day. Please click here for further physical requirement detail.
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 regard 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.
Seniority Level Mid‑Senior level
Employment Type Full‑time
Job Function Finance and Sales
#J-18808-Ljbffr