Medical Informatics Analyst, Senior

Blue Shield of California • Oakland, CA

19d

About The Position

Your Role The ASO and Specialty Pricing team supports rate filing, discount submission, and financial analysis for Blue Shield of California in the ASO and Specialty space. The Medical Informatic – Senior role will report to the Senior Manager of Pricing for Select & Specialty. In this role you will be responsible for extracting and analyzing data to support UDS submissions and other large data sets as well as other actuarial analysis and reporting. Responsibilities Your Work In this role, you will: 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 Extract and analyze data to support UDS submissions and other large data sets

Requirements

• Requires an MPH, MBA, MS, MA, RN, or RHIA in health science, quantitative social science, public health, health services research or business, or BA/BS with demonstrated equivalent work experience
• Requires SAS Certified Base Programmer Credential or equivalent
• Requires at least 5 years of prior relevant experience
• Requires at least 3 years of experience in Health Care (managed care, academic, or gov't payer)

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
• Extract and analyze data to support UDS submissions and other large data sets

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level