Job Description

Your Role

The Risk Adjustment Analytics & Reporting team is looking for an Experienced Actuarial Analyst. The Experienced Actuarial Analyst will report to the Manager of Risk Adjustment Analytics & Reporting. In this role you will create and own various analytical projects that assist providers in accurately capturing the risk score of their member populations. Additional responsibilities include supporting the member suspecting process as well as supporting Blue Shield’s prospective programs.

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
• Direct, coordinate, and/or develop evaluation and financial reporting standards for internal and external reports
• Quantify and project risk scores and revenue for the Medicare line of business
• Conduct complex actuarial analyses to assess risk scores, including performing root cause analysis
• Create data-driven solutions for capturing risk and improving quality of care for our members
• Perform vendor return on investment analyses to determine ongoing benefit and decision support
• Perform other responsibilities as assigned

Your 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 2 years of professional actuarial experience
• Requires one to be an independent, proactive problem solver with patience for working on large scale problems
• Requires strong technical skills
• Programming knowledge required (SAS and/or VBA preferred), including sample code (in any language)
• Requires proficiency with Microsoft Excel
• Preferred 4+ exams completed in the Society of Actuaries exam process (but not required)

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