Actuarial Analyst, Consultant

The Risk Adjustment Retrospective Analytics team focuses on delivering complete and accurate analytics for chart review targeting, financial impact calculations, and data submission. The Actuarial Analyst, Consultant, will report to the Manager of Risk Adjustment Retrospective Analytics. In this role you will develop and refine chart targeting lists, quantify the financial impact of the Retrospective program, and support complete and accurate data submission for both Medicare Advantage and ACA Chart Review Programs.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

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
• Direct, coordinate, and/or develop evaluation and financial reporting standards for internal and external reports
• Ensure accuracy and completeness of vendor data templates for chart retrieval and coding by performing thorough data validations
• Review and validate the targeted chart list to confirm alignment with Retrospective program objectives and maintain compliance standards

• 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
• Requires proficiency with MS Office, including Excel, Word, Power Point
• Requires ability to create and validate new and existing data analytic processes, in context of broader enterprise objectives
• Program management skills, along with related ability to rapidly diagnose to root-cause of analytic problems preferred
• Requires finance experience, including revenue and expense accounting, healthcare enrollment and claims processing experience, and healthcare experience
• Experience with HHS-Developed Risk Adjustment Model Algorithm for the commercial market preferred
• Requires excellent written and spoken communication skills of technical material to executive leadership
• Preferred:
  An ASA designation and completion of 1 to 2 courses toward FSA designation

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…