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.
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
At Blue Shield of California we are parents, leader, students, visionaries, heroes, and providers. Everyday we come together striving to fulfill our mission, to ensure all Californians have access to high-quality health care at a sustainably affordable price. For more than 80 years, Blue Shield of California has been dedicated to transforming health care by making it more accessible, cost-effective, and customer-centric. We are a not-for-profit, independent member of the Blue Cross Blue Shield Association with 6,800 employees, more than $20 billion in annual revenue and 4.3 million members. The company has contributed more than $500 million to Blue Shield of California Foundation since 2002 to have a positive impact on California communities. Blue Shield of California is headquartered in Oakland, California with 18 additional locations including Sacramento, Los Angeles, and San Diego. We’re excited to share Blue Shield of California has received awards and recognition for LGBT diversity, quality improvement, most influential women in corporate America, Bay Area’s top companies in volunteering & giving, and one of the world’s most ethical companies. Here at Blue Shield of California, we’re striving to make a positive change across our industry and the communities we live in , Join us!
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)