Blue Shield of California · 6 days ago
Actuarial Analyst, Consultant
Oakland, CA, United States
Full-time
Hybrid
Senior Level
$139K/yr - $208K/yr
6+ years expBlue Shield of California is a nonprofit organization committed to transforming healthcare. The Actuarial Analyst, Consultant will lead financial analyses and modeling for provider contracting support, working closely with the Network and Trend Analytics team to drive the development of an affordable provider network.
Financial ServicesHealth InsuranceNon Profit
No H1B
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
Qualification
Required
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
Preferred
Experience with financial analysis of provider contracts and common reimbursement methodologies
Company
Blue Shield of California
Blue Shield of California is a health insurance service provider.
5001-10000 employees
Funding
Current Stage
Late StageLeadership Team
Gary Culp
Senior Vice President, Government Markets
Gregory Siebert
Senior Vice President Provider Partnerships & Network Management
Recent News
2026-01-13
Fierce Healthcare
2025-12-15
Company data provided by crunchbase