Actuarial Analyst, Senior

Join the Actuarial Pay for Value team and help Blue Shield lead the industry in value-based care innovation, setting the standard for how care is paid for. Reporting to the Senior Manager, Actuarial Pay for Value, you will develop the strategies and financial models behind our value-based payment programs, including hospital value models, episode-based specialty care models, and vendor partnerships across a wide range of clinical areas such as orthopedics, maternity, oncology, and behavioral health.

Engaged from strategy and design through contracting, implementation, and ongoing operations, you will partner with clinical, network, finance, and operations leaders to turn complex data into actionable recommendations. In this highly visible role, you will work directly with senior leaders to build solutions that advance affordability and quality for Californians.

Join the Actuarial Pay for Value team and help Blue Shield lead the industry in value-based care innovation, setting the standard for how care is paid for. Reporting to the Senior Manager, Actuarial Pay for Value, you will develop the strategies and financial models behind our value-based payment programs, including hospital value models, episode-based specialty care models, and vendor partnerships across a wide range of clinical areas such as orthopedics, maternity, oncology, and behavioral health.

Engaged from strategy and design through contracting, implementation, and ongoing operations, you will partner with clinical, network, finance, and operations leaders to turn complex data into actionable recommendations. In this highly visible role, you will work directly with senior leaders to build solutions that advance affordability and quality for Californians.

• Understand the core principles and functionality of decision, descriptive and predictive 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 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 SQL, Python, R) and deploys 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
• De velop evaluation and financial reporting standards for internal and external reports
• Design innovative value-based payment strategies and arrangements, including hospital value models, shared savings, episode-based models, and global budgets, from concept through contracting
• Build financial models and forecasts that quantify cost, savings, and risk to guide contract terms, pricing, and investment decisions
• Evaluate specialty vendor and clinical program performance, including fee structures, ROI, engagement, and performance guarantees, and recommend whether to expand, renegotiate, or discontinue
• Support implementation and ongoing operations, including attribution, payment and reconciliation methodologies, and performance reporting
• Use AI-enabled tools and automation to streamline analytics, accelerate insights, and improve reporting efficiency
• Present insights and recommendations to senior leaders and partner with them to shape provider payment strategy
• Lead analytical work streams end to end with minimal supervision and mentor junior actuarial staff

• Requires a bachelor’s degree in mathematics, statistics, actuarial science, computer science, or a related field
• Requires 5 years of prior relevant experience delivering pricing, reserving, forecasting, or risk analytics
• Requires hands-on experience working with medical and pharmacy claims, eligibility, and provider reimbursement data
• Requires advanced proficiency in Excel and SQL or a comparable language such as Python or R; experience with cloud-based data platforms such as Databricks or Microsoft Fabric preferred
• Requires strong communication,…