Senior Actuarial Analyst: Value-Based Care Innovator

Blue Shield of California; California; Hybrid; USD 103,000 - 154,000; Full time

Job summary

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

Responsibilities

• 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

Skills

Communication skills

Problem solving

Project management

Education

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

Tools

SQL

Python

R

Excel

Databricks

Microsoft Fabric

Job description

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