JOB DESCRIPTION
Your Role

The Medicare Risk Adjustment Prospective Program team focuses on transforming health care by making it more accessible, affordable and customer-centric. The Actuarial Analyst, Consultant will report to the Senior Manager of Risk Adjustment. In this role you will provide essential support to the In-Office Assessment program within the Risk Adjustment team. This includes interaction within the Risk Adjustment team, with various cross-functional teams within Blue Shield, Blue Shield IPA/MG and working directly with our vendors supporting our Risk Adjustment In-Office programs. The ideal candidate possesses excellent interpersonal skills, project management skills, organizational skills, has high attention to detail, and is self-motivated. The candidate will also possess a desire to continually learn.

Your Work

In this role, you will:

• Understand the core principles and functionality underlying decision, descriptive, predictive, and prescriptive advanced analytic methods
• 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.
• Direct, coordinate and/or develop strategic, market and competitive analysis
• Proactively assists vendor management efforts around In-Office Assessment program and tracks performance to keep vendor on task
• Proactively collaborates with other teams within the Risk Adjustment department, as well as with other departments
• Performs analytics to improve the In-Office Assessment program
• Ensures program operations, such as reporting, reconciliations, invoices and audits, are timely
• Manage projects/timelines to achieve successful outcomes

QUALIFICATIONS
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
• Requires excellent interpersonal, verbal and written communication and presentation skills
• Requires strong interpersonal skills and the ability to collaborate with other cross-functional areas to meet objectives
• Requires the ability to manage projects/timelines to achieve successful outcomes
• Requires excellent organization skills and high attention to detail
• Must be an independent problem solver, be proactive with approach when managing multiple projects and have patience when working on large scale problems
• Requires proficiency with MS Office (Excel, Word, PowerPoint and Visio)

ABOUT THE TEAM
Blue Shield of California’s mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that truly serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our comprehensive approach to diversity, equity, and inclusion combines a focus on our people, processes, and systems with a deep commitment to promoting social justice and health equity through our products, business practices, and presence as a corporate citizen.

Blue Shield has received awards and recognition for being a certified Great Place to Work, best place to work for LGBTQ equality, leading disability employer, one of the best companies for women to advance, Bay Area’s top companies in volunteering & giving, and one of the world’s most ethical companies. Here at Blue Shield of California, we are striving to make a positive change across our industry and the communities we live in – 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 be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes.
• Courageous . We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

From the earliest days of the pandemic, Blue Shield of California has been unyielding in our commitment to putting the health and safety of our people, our members and our communities first. As a health care company, Blue Shield requires all employees to be up to date with COVID-19 vaccination prior to start date as a condition of employment. Blue Shield will consider requests for medical or religious accommodation to this vaccination requirement prior to your start date.

The definition of "up to date with your COVID-19 vaccine" is when you have received all doses in the primary series and one booster when eligible. If you are unable to be up to date with your COVID-19 vaccine by your start date, your start date will need to be postponed and you will have 30 days to remedy. If you cannot fulfill the requirement nor obtain an accommodation within 30 days, your offer will be rescinded.