Actuarial Analyst, Senior

In this role, you will: 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 workstreams end to end with minimal supervision and mentor junior actuarial staff Your Knowledge and Experience 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, problem-solving, and project management skills, with the ability to present complex analyses clearly to leadership

Preferred: Experience developing dashboards, data models, or reporting solutions using tools such as Power BI or Tableau

Preferred: Experience with value-based care, provider contracting, alternative payment models, or vendor/program evaluation

Preferred: Attained ASA, Associate of the Society of Actuaries

Preferred: Attained FSA, Fellow of the Society of Actuaries

About Us: As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies. At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience. To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals. Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities – join us!

Our Values: Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short. Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives. Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals. Our Workplace ModelWe believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility: For most teams, this means coming into the office two days per week. Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need. For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being. The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.

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.

Equal Employment Opportunity: 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.