Actuarial Analyst, Senior

Your Role

The Pay for Value team supports the program design, budget setting, and operations of Blue Shield of California’s value-based care (VBC) payment models, including Accountable Care Organization (ACO), Virtual Care, and other innovative incentive programs. The Actuarial Analyst, Senior will report to the Actuarial Manager of the Pay for Value team. In this role you will both lead and support reporting and analytical work across various programs, collaborating with colleagues from diverse backgrounds and roles within the company.

The Pay for Value team supports the program design, budget setting, and operations of Blue Shield of California’s value-based care (VBC) payment models, including Accountable Care Organization (ACO), Virtual Care, and other innovative incentive programs. The Actuarial Analyst, Senior will report to the Actuarial Manager of the Pay for Value team. In this role you will both lead and support reporting and analytical work across various programs, collaborating with colleagues from diverse backgrounds and roles within the company.

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 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
• Develop evaluation and financial reporting standards for internal and external reports
• Lead and support program reporting and analytics, including cost target setting, reconciliation, forecasting, and "what‑if" modeling to inform strategy development
• Collaborate with internal teams and cross‑functional partners to support program development and ensure alignment with BSC healthcare affordability and quality objectives
• Perform ad‑hoc actuarial analyses to support various business needs and provide actionable insights and recommendations based on these analyses
• Understand how other network initiatives and alternate payment models interplay and affect VBC programs and relationships

• Requires a bachelor’s degree with at least a minor in mathematics, statistics, computer science or equivalent business experience
• At least 3 years of professional actuarial experience
• Requires advanced experience with Microsoft Excel and/or SAS/SQL
• Requires strong communication and presentation skills
• Requires attention to detail and ability to manage multiple priorities
• Experience with data visualization tools such as Power BI and/or Tableau preferred
• Healthcare industry experience preferred

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…