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Actuarial Analyst

Company: Blue Shield of California
Location: Oakland
Posted on: June 6, 2021

Job Description:

Job summary

Network Analytics is an analytical function under Data & Analytics division in IT department and provides professional and ancillary provider analytics, supporting negotiations and reimbursement models. We utilize claims and membership data and other sources of information to evaluate and build models to assess financial impact of provider negotiations. We are responsible for modeling unit cost trend projections. We also manage several in-network and out-of-network fee schedules, which we routinely update to ensure market competitiveness and regulatory compliance. We work closely with Health Quality and Affordability, Health Transformation, Finance and other D&A / IT teams and partners.

This position will work with a various team focused on professional and ancillary provider reimbursement analytics. In this role you will collect, analyze, synthesize information, and guide business decision making for BSC network management, cost of healthcare, healthcare transformation and innovation, and network design and strategies.

You will work closely with various teams throughout the organization, acting as both team leader and member, supporting the team's overall objectives. Use SAS / SQL and Tableau to design, build, enhance, and manage complex data systems and analysis methods that better serve ongoing analytical and reporting requirements. Identify opportunities and make recommendations and/or implement solutions. Act as facilitator, trainer, consultant and mentor to team members and analysis throughout the organization. Use technical, analytical, clinical, and financial knowledge to assess the completeness and reliability of data and the validity and accuracy of analytical results. Lead and guide peers with analytical best practices and methods, coordination and oversight, peer reviews, and training sessions.


  • Active participant in developing provider strategy. Interprets data to make informed decisions in the market.
  • Prepares financial Models to support contracting strategy and provides guidance to Contract Managers.
  • Conducts analysis of high complexity related to cost of healthcare savings initiatives.
  • Performs termination and disengagement analyses for medical groups that are either teminating or disengaging their contract with BSC.
  • Clearly communicates analytical results in presentations, or report to various levels of management and cross functional departments
  • Use SAS / SQL to design, build, enhance, and manage complex data systems and analysis methods that better serve ongoing analytical and reporting requirements.
  • Use Tableau / Excel to design, maintain dashboard and self-service reporting.
  • Extract, clean, analyze and summarize historical claims experience efficiently with SAS or other tools.

Knowledge and Experience

  • Typically requires 3 to 5 years of professional experience.
  • Typically requires at least 2 years of health care industry background.
  • Strong statistical knowledge.
  • Strong analytics skills and technically savvy.
  • Expert level in SAS/SQL.
  • Tableau and Data Visualization experience is highly desired.
  • Strong communications skills.
  • Be comfortable working with data.
  • Have intellectual curiosity and be a self-starter.
  • Strong problem-solving skills.
  • Enjoy working within a team and independently.
  • College degree with at least a minor in mathematics, statistics, computer science or equivalent business experience.

Additional Information

  • About Company: 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!
  • Physical Requirements:

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Please click here for further physical requirement detail.

  • EEO Footer: External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.
  • Requisition ID: 21001GR
  • Posting Date: Apr 1, 2021
  • Schedule: Full-time

Keywords: Blue Shield of California, Oakland , Actuarial Analyst, Other , Oakland, California

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