About this role
Your Role
Join the Actuarial Pay for Value team and help Blue Shield lead the industry in value-based care innovation, setting the standard for how care is paid for. Reporting to the Senior Manager, Actuarial Pay for Value, you will develop the strategies and financial models behind our value-based payment programs, including hospital value models, episode-based specialty care models, and vendor partnerships across a wide range of clinical areas such as orthopedics, maternity, oncology, and behavioral health. Engaged from strategy and design through contracting, implementation, and ongoing operations, you will partner with clinical, network, finance, and operations leaders to turn complex data into actionable recommendations. In this highly visible role, you will work directly with senior leaders to build solutions that advance affordability and quality for Californians.
Your Knowledge and Experience
- Requires a bachelor’s degree in mathematics, statistics, actuarial science, computer science, or a related field
- Requires 5 years of prior relevant experience delivering pricing, reserving, forecasting, or risk analytics
- Requires hands-on experience working with medical and pharmacy claims, eligibility, and provider reimbursement data
- Requires advanced proficiency in Excel and SQL or a comparable language such as Python or R; experience with cloud-based data platforms such as Databricks or Microsoft Fabric preferred
- Requires strong communication, problem-solving, and project management skills, with the ability to present complex analyses clearly to leadership
- Preferred: Experience developing dashboards, data models, or reporting solutions using tools such as Power BI or Tableau
- Preferred: Experience with value-based care, provider contracting, alternative payment models, or vendor/program evaluation
- Preferred: Attained ASA, Associate of the Society of Actuaries
- Preferred: Attained FSA, Fellow of the Society of Actuaries
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.