Actuarial Analyst, Consultant

Your Role

The Actuarial Pay for Value team serves as a strategic partner to Blue Shield leadership in designing and advancing innovative payment models, value-based care strategies, provider incentives, and new program concepts that improve affordability, quality, provider performance, and member outcomes across the enterprise. The Actuarial Analyst, Consultant will report to the Senior Manager, Actuarial Pay for Value. In this role, you will serve as a lead actuarial subject matter expert responsible for shaping enterprise payment and value-based care strategies, developing new program concepts, evaluating financial impact, and translating innovative ideas into scalable solutions that improve affordability, quality, provider performance, and member outcomes.

You will partner cross-functionally with business, clinical, operational, technology, finance, and provider stakeholders to guide complex workstreams from concept through implementation, influence recommendations, navigate ambiguity, and provide direction and review for junior team members.

Your Knowledge and Experience

• Requires a college degree with at least a minor in mathematics, statistics, computer science or equivalent business experience
• Requires at least 6 years of professional actuarial experience
• Typically, has obtained their ASA designation and has completed 1 to 2 courses toward their FSA designation
• Required experience in healthcare actuarial analytics, provider reimbursement, value-based care, pricing, forecasting, reserving, risk adjustment, provider contracting, or related financial modeling
• Required advanced proficiency in Excel and analytical programming languages such as SQL, Python, and SAS, with demonstrated experience developing financial models, forecasting methodologies, pricing and savings analyses, analytical frameworks, automation solutions, and decision-support tools
• Required ability to independently develop multiple potential solutions to complex and ambiguous business problems, formulate recommendations with supporting rationale, influence decisions without direct authority, and manage large cross-functional projects or processes
• Required ability to communicate complex actuarial findings and strategic recommendations to technical and non-technical audiences, including leadership and cross-functional stakeholders
• Desired experience guiding, mentoring, delegating work to, and reviewing work products for junior actuarial analysts or other quantitative professionals
• Desired experience with Tableau, Power BI, data visualization technologies, dashboard development, reporting automation, executive reporting solutions, and visually compelling decision-support tools

Hybrid

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.

Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.

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 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 analytical programming languages including Python, SQL, and SAS, and deploy predictive analytics and machine learning techniques to improve forecasting, financial modeling, risk prediction, and operational efficiencies

• Direct, coordinate, and/or develop evaluation and financial reporting standards for internal and external reports

• Lead the development of new Pay for Value programs, provider payment strategies, and analytical frameworks that advance affordability, quality, provider performance, and member outcomes.

• Evaluate and shape strategic initiatives through financial modeling, ROI analyses, savings assessments, forecasting methodologies, vendor evaluations, and program design recommendations that support investment and implementation decisions.

• Lead cross-functional collaboration across business, clinical, operational, technology, finance, and provider stakeholders to translate strategic concepts into actionable plans, build alignment, navigate ambiguity, resolve issues, and move initiatives from ideation through execution

• Develop innovative, visually compelling, and professionally designed analytical tools, dashboards, forecasting models, and executive reporting packages that transform complex data into actionable insights and support decision-making

• Provide guidance, delegation, peer review, and technical support to junior actuarial staff while serving as a primary point of contact for questions related to assigned Pay for Value workstreams

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 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 analytical programming languages including Python, SQL, and SAS, and deploy predictive analytics and machine learning techniques to improve forecasting, financial modeling, risk prediction, and operational efficiencies

• Direct, coordinate, and/or develop evaluation and financial reporting standards for internal and external reports

• Lead the development of new Pay for Value programs, provider payment strategies, and analytical frameworks that advance affordability, quality, provider performance, and member outcomes.

• Evaluate and shape strategic initiatives through financial modeling, ROI analyses, savings assessments, forecasting methodologies, vendor evaluations, and program design recommendations that support investment and implementation decisions.

• Lead cross-functional collaboration across business, clinical, operational, technology, finance, and provider stakeholders to translate strategic concepts into actionable plans, build alignment, navigate ambiguity, resolve issues, and move initiatives from ideation through execution

• Develop innovative, visually compelling, and professionally designed analytical tools, dashboards, forecasting models, and executive reporting packages that transform complex data into actionable insights and support decision-making

• Provide guidance, delegation, peer review, and technical support to junior actuarial staff while serving as a primary point of contact for questions related to assigned Pay for Value workstreams