Job Description

Your Role

The The Network and Trend Analytics (NTA) team supports the Network Management team with analytical and financial modeling for provider contracting and network development activities for Blue Shield of California. The Manager, Actuary of NTA will report to the Senior Director of NTA. In this role you will be responsible for the provider unit cost trend budgeting and forecasting including the analytics supporting the long-term network strategic goals. Additional responsibilities include supporting the ancillary network strategy and development, oversight of out-of-network fee schedules and maintenance of key modeling tools and reports. You will have a team of 4 analysts to support you in this work. 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.

Responsibilities

Your Work

In this role, you will:

Have overall responsibility and accountability for reviewing staff work product related to reserving, CMS/ACA related risk adjustment processes, pricing, forecasting, trend setting, and/or network development and alternative provider payment models
Be responsible for developing and managing experience tracking reports, comparisons to plan, tracking and quantifying variances and shares insights with the business unit and management
Ensure team follows existing work flow procedures or policies and/or validate or develop new procedures and policies
Be responsible for understanding current and emerging regulatory and competitive developments, facilitating communication of these developments, and ensuring processes and procedures are consistent with changing regulations
Lead special projects/ committees/task forces
Be responsible for unit cost trend forecasting including the budgeting and tracking process and interactions with the company-wide trendsetter process
Oversight of out-of-network fee schedules which includes periodic maintenance and development of fee schedules to be compliant with regulatory requirements
Supports the Ancillary Network team with contract renewal support as well as actuarial modeling support for strategic initiatives
Be responsible for maintaining the hospital cost model as well as actuarial tools supporting provider termination activities

Qualifications

Your Knowledge and Experience

Requires a bachelor's degree in actuarial science, mathematics, statistics, computer science or equivalent experience
Requires at least 7 years prior relevant job including 3 years of experience of operating in a team leader role
Associate of Society of Actuaries (ASA) preferred or nearing completion of ASA requirements
Requires strong understanding of actuarial principles and the application to the health insurance industry
Requires strong ability to communicate complex technical subjects to non-technical audiences
Requires strong project and team management skills
Requires strong problem-solving skills, self-motivation, detail orientation and critical thinking skills

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.

At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.

Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities - join us!

Our Values:

Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

Our Workplace Model:

At Blue Shield of California and the Ascendiun Family of Companies, we believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility. As we continue to evolve our workplace model, our focus remains on creating spaces where our people can connect with purpose - whether working in the office or through a hybrid approach - by providing clear expectations while respecting the diverse needs of our workforce.

Two Ways of Working:

Hybrid (Default): Work from a business unit-approved office at least two (2) times per month (for roles below Director-level) or once per week (for Director-level roles and above).Exceptions:

o Member-facing and approved out-of-state roles remain remote.

o Employees living more than 50 miles from their assigned offices are expected to work with their managers on a plan for periodic office visits.

o For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.

On-Site: Work from a business unit-approved office an average of four (4) or more days a week.

Physical Requirements:

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Please click here for further physical requirement detail.

Equal Employment Opportunity:

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.

This role has closed

This role has closed