Actuarial Analyst, Consultant

Blue Shield of California•Oakland, CA

About The Position

Your Role The Network and Trend Analytics team drives the development of an affordable provider network through data analytics and expertise. The Actuarial Analyst, Consultant will report to the Senior Manager. In this role, you will lead and perform financial analyses and modeling for provider contracting support including term changes, renewals, network changes, and terminations for physician groups, hospitals, ambulatory surgery centers, and other types of providers Responsibilities Your Work In this role, you will: 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

Requirements

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

Nice To Haves

Experience with financial analysis of provider contracts and common reimbursement methodologies is preferred

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