Actuarial Analyst, Senior

Blue Shield of California; California; Hybride; USD 103 000 - 154 000; Plein temps

Résumé du poste

Blue Shield of California is seeking an Actuary to lead value-based payment strategies, building financial models for hospital and episode-based care while partnering with clinical, network, finance, and operations leaders. The role spans strategy, design, contracting, implementation, and ongoing operations to advance affordability and quality for Californians.

The position emphasizes collaboration with senior leaders, development of sophisticated analytics, and the use of AI-enabled tools to

Qualifications

• 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

Responsabilités

• 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 statistical programming languages (including 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

Connaissances

Communication skills

Problem solving

Project management

Formation

Bachelor’s degree in mathematics, statistics, actuarial science, computer science

Outils

SQL

Python

R

Excel

Databricks

Microsoft Fabric

Description du poste

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.

Job Description

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.

Responsibilities

Your Work

• 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
• De velop 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

Qualifications

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.

About Us

About Blue Shield of California

As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.

At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.

Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities – 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 listen and communicate effectively, showing empathy by understanding others' perspectives.
• Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

Our Workplace Model

We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:

• For most teams, this means coming into the office two days per week.
• Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in‑office time based on business need.
• For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well‑being.

Physical Requirements:

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency 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 regards 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.

JOB INFO

Job Identification : 20261984

Job Category : Actuarial Services

Posting Date : 2026-10-12T18:58:31+00:00

Job Schedule : Full time

Locations :

Oakland, CA, United States

CA, United States

Pay Range for California : $102740.00 to $154220.00

Pay Range for Bay Area : $115816.00 to $173848.00

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 experience, location (California, Bay Area, or outside California), and current employee salaries for similar roles.

Role can be filled by a candidate requiring sponsorship : No