Job Description

Your Role

The Actuarial Pay for Value team serves as a strategic partner to Blue Shield leadership in developing innovative payment models, value-based care strategies, and provider incentives that advance affordability, quality, provider performance, and member outcomes across the enterprise. The Actuarial Analyst, Principal will report to the Senior Manager, Actuarial Pay for Value and directly manage a team of two actuarial professionals. In this highly visible leadership role, you will work directly with senior and executive leaders across Blue Shield to shape and execute key enterprise strategies, design creative solutions to complex healthcare challenges, evaluate emerging market opportunities, and drive transformational initiatives from concept through implementation.

Combining actuarial expertise, strategic thinking, innovation, and people leadership, you will help define the future direction of Blue Shield's Pay for Value programs and provider partnerships while delivering measurable impact on the organization's long-term affordability, quality, and value-based care objectives. This role will have significant visibility with senior leadership and influence some of Blue Shield's most critical affordability, provider transformation, and value-based care initiatives.

Responsibilities

Your Work

In this role, you will:

• Understand the core principles and functionality underlying decision, descriptive, predictive, and prescriptive advanced analytic methods
• 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
• Lead, coordinate and/or develop strategic, market and competitive analysis
• Lead innovative payment and value-based care strategies that address complex healthcare challenges and drive affordability, quality, provider performance, and member outcomes
• Lead development and evaluation of complex financial models, forecasting methodologies, ROI analyses, savings assessments, accrual methodologies, and vendor evaluations to support strategic business decisions
• Lead cross-functional collaboration across business, clinical, operational, technology, finance, and provider stakeholders to drive organizational change, translate strategic concepts into actionable plans, build alignment, navigate ambiguity, resolve complex issues, and implement 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 strategic decision-making
• Manage, mentor, and guide a team of two actuarial professionals by providing coaching, technical leadership, and career development support while helping team members navigate ambiguity, evolving priorities, and complex business challenges

Qualifications

Your Knowledge and Experience

• Requires a college degree in mathematics, statistics, actuarial science, economics, computer science or equivalent business experience
• Requires an ASA and must be working towards FSA if not complete
• Requires at least 8 years of professional actuarial experience
• Required experience leading complex actuarial and strategic initiatives with significant organizational impact, influencing decisions without direct authority, driving alignment across cross-functional stakeholders, and managing multiple priorities in a dynamic environment
• Required expert-level proficiency in Excel and analytical programming languages such as SQL, Python, and SAS, with demonstrated experience developing sophisticated financial models, forecasting methodologies, pricing and savings analyses, analytical frameworks, automation solutions, and scalable decision-support tools
• Required experience managing, mentoring, and developing actuarial analysts or other quantitative professionals, including performance management, coaching, technical development, and career growth
• Required ability to communicate complex actuarial findings and strategic recommendations to technical and non-technical audiences, including senior and executive leadership
• 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.

About the Team

About Blue Shield of California

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.