Actuarial Analyst, Consultant

at  Blue Shield of California

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
• Have overall responsibility and accountability for leading and managing pharmacy support work products related to target setting, reconciliation, and reporting (internal and/or external) for Pharmacy related programs.
• Lead and/or support other general program operations work, ranging from savings projection, accrual setting, addressing data issues and developing solutions, executing program renewals/conversions, iterative model design changes, improving and streamlining operations efficiency
• Direct, coordinate, and/or develop evaluation and financial reporting standards for internal and external reports
• Lead, coordinate and/or develop strategic, market and competitive analysis
• Ensure team follows existing, validates, and/or develops new work-flow procedures or policies
• Be responsible for establishing and maintaining relationships with internal/external stakeholders

QUALIFICATIONSYOUR KNOWLEDGE AND EXPERIENCE

• 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
• Prior experience related to pharmacy analytic modeling preferable
• Strong technical abilities to program in SAS, compressing large volumes of data
• Requires an ASA
• Strong project management skillsStrong problem-solving skills, self-motivation, detail orientation and critical thinking skills

PHYSICAL REQUIREMENTS:

Office Environment - roles involving part to full time schedule in Office Environment. Due to the current public health emergency in California, Blue Shield employees are almost all working remotely. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

JOB DESCRIPTIONYOUR ROLE

The Cost of Healthcare Trendsetters & Pharmacy Support team analyzes and provides emerging healthcare cost trend drivers. The Actuarial Analyst, Consultant will report to the Actuarial Manager. In this role you will provide .

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
• Have overall responsibility and accountability for leading and managing pharmacy support work products related to target setting, reconciliation, and reporting (internal and/or external) for Pharmacy related programs.
• Lead and/or support other general program operations work, ranging from savings projection, accrual setting, addressing data issues and developing solutions, executing program renewals/conversions, iterative model design changes, improving and streamlining operations efficiency
• Direct, coordinate, and/or develop evaluation and financial reporting standards for internal and external reports
• Lead, coordinate and/or develop strategic, market and competitive analysis
• Ensure team follows existing, validates, and/or develops new work-flow procedures or policies
• Be responsible for establishing and maintaining relationships with internal/external stakeholder