Your Role
The Actuarial Provider Strategies team is responsible for partnering with the Blue Shield Health Solutions teams on developing, scaling and executing provider-focused strategies that promote high quality, affordable health care. The Network-Growth Partnership role will report to the Vice President of Actuarial Provider Strategies. In this role you will be responsible for converting pricing and financial goals at the line of business and region level into specific action plans at the provider level that the Network team can execute.
Your Work
In this role, you will:
- Be responsible for converting pricing and financial goals at the line of business and region level into specific action plans at the provider level that the Network team can execute
- Create value for the Growth team General Managers by ensuring they have a voice when it comes to key network decisions and network strategy
- Create value for the Network team by organizing and focusing the various requests from the General Managers and Pricing Team into a prioritized, workable list
- Be required to have strong influencing skills across multiple functions within Blue Shield with a drive towards consensus, and an ability to handle shifting priorities and ambiguity with agility
- Lead, coordinate and/or develop strategic, market and competitive analysis
- 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
Your Knowledge and Experience
- Requires a bachelor's degree in mathematics, statistics, computer science or equivalent business experience
- Requires an ASA
- Requires at least 8 years of professional actuarial experience
- Requires at least 1 year of pricing experience, with experience in multiple lines of business desired
- Requires at least 2 years of experience in actuarial provider contracting analysis