Company: Blue Shield of California
Posted on: June 6, 2021
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
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
- Clearly communicates analytical results in presentations, or
report to various levels of management and cross functional
- 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
- 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
- Typically requires at least 2 years of health care industry
- Strong statistical knowledge.
- Strong analytics skills and technically savvy.
- Expert level in SAS/SQL.
- Tableau and Data Visualization experience is highly
- 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
- 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
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
- Requisition ID: 21001GR
- Posting Date: Apr 1, 2021
- Schedule: Full-time
Keywords: Blue Shield of California, Oakland , Actuarial Analyst, Other , Oakland, California
Didn't find what you're looking for? Search again!