Actuarial Analyst, Sr. Principal

Company: Blue Shield of California
Location: Oakland
Posted on: May 8, 2025

Job Description:

Your Role The Sr. Principal Actuarial Analyst for our Medi-Cal team is responsible for overseeing rate development & rate analysis, Medi-Cal program analysis, experience reporting, and Medi-Cal program strategy. This position requires directly managing 1 actuarial analyst and partnering with Senior Leadership and cross-functional teams to drive successful strategy and analytics. This role will report directly to the Senior Director of Medicare Finance & CFO Promise Health Plan. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.Your Work In this role, you will:

• Rate Development/Analysis; Influence & Negotiation
  • Be responsible for developing, updating, and evaluating all rate packages from DHCS including development factors, trend support, actuarial assumptions, program analysis, and risks or opportunities
  • Report to the CFO of Promise Health Plan and senior executives of Promise Health Plan financial opportunities and areas of focus for performance optimization
  • Assist with, and influence, rate negotiation and rate guidance
  • Revenue & Cost of Healthcare Forecasting for Medi-Cal / Promise Health Plan
    • Develop, implement, manage and own advanced analytics projects from end to end and proactively add improvements and enhancements
    • Explain and influence the project to audiences outside the job function and to senior leaders. Will drive and ensure alignment of project with team goals and long-term strategic goals
    • 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
    • Medi-Cal Program Actuarial Support & Revenue optimization
    • Financial and Actuarial Process support and Talent development
    • Medi-Cal strategy development & program planning
      • Acts as the lead subject matter expert in the data areas of claim, premium, membership, and/or risk score assignment
      • Work closely with Senior Leadership at Promise Health Plan to understand strategic direction and financial strengths and opportunities
      • Partner with financial and actuarial leaders to strengthen finance and actuarial processes and build strong talent pipelines
      • Partner with CFO of Promise Health Plan on annual budget setting process and on-going forecasting processes
      • Responsible for evaluating and explaining monthly financial variances to plan for revenue and cost of healthcare
      • Understand the core principles and act as an expert within a specialized discipline, along with the functionality underlying decision, descriptive, predictive and prescriptive advanced analytic methods Your Knowledge and Experience
        • Requires a college degree in mathematics, statistics, computer science or equivalent business experience
        • Requires 10 years of professional health actuarial experience.
        • Requires a minimum of 5 years of experience in health actuarial pricing
        • Requires an ASA
        • Requires expertise in the California Medi-Cal program, from either the carrier or consultant side
        • Requires experience in rate development, rate analysis, and performance evaluation of a health plan
        • Requires extensive knowledge of job area (including health plan operations) and regulations obtained through professional experience and advanced education
        • Requires a mastery level knowledge within the Actuarial job area and may have deeper knowledge of project management
        • Requires a high proficiency in applied statistics skills, such as distributions, statistical testing, and regression
        • Requires the ability to program in SQL, SAS and/or Tableau, and experience with common data science toolkits such as R and Python

Keywords: Blue Shield of California, Milpitas , Actuarial Analyst, Sr. Principal, Education / Teaching , Oakland, California