Blue Shield of California · 4 days ago
Actuarial Analyst, Consultant
Oakland, CA
Full-time
Hybrid
Senior Level
6+ years expBlue Shield of California is a nonprofit organization focused on transforming health care to be more affordable and effective. The Actuarial Analyst, Consultant will develop and refine analytics for financial impact calculations and data submission, while also conducting risk assessments and developing actuarial formulations to support pricing and reimbursement strategies.
Financial ServicesHealth InsuranceNon Profit
Responsibilities
Understand the core principles and functionality of decision, descriptive, predictive, and prescriptive 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 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 deploy 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 evaluation and financial reporting standards for internal and external reports
Ensure accuracy and completeness of vendor data templates for chart retrieval and coding by performing thorough data validations
Review and validate the targeted chart list to confirm alignment with Retrospective program objectives and maintain compliance standards
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 proficiency with MS Office, including Excel, Word, PowerPoint
Requires ability to create and validate new and existing data analytic processes, in context of broader enterprise objectives
Requires finance experience, including revenue and expense accounting, healthcare enrollment and claims processing experience, and healthcare experience
Requires excellent written and spoken communication skills of technical material to executive leadership
Preferred
Program management skills, along with related ability to rapidly diagnose to root-cause of analytic problems preferred
Experience with HHS-Developed Risk Adjustment Model Algorithm for the commercial market preferred
Preferred: An ASA designation and completion of 1 to 2 courses toward FSA designation
Company
Blue Shield of California
Blue Shield of California is a health insurance service provider.
5001-10000 employees
H1B Sponsorship
Blue Shield of California has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2023 (1)
2022 (41)
2021 (20)
2020 (31)
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
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