Your Role
The Corporate Actuarial team is responsible for Health Plan's Incurred but Not Reported (IBNR) valuations, trendsetting and other actuarial projections. The Senior Director, Actuary, Corporate Actuarial will report to the Chief Actuary. In this position, you will be responsible and accountable for the results of actuarial functional areas related to reserving, trend setting, risk score forecasting, and ad-hoc analysis on healthcare cost initiatives.
Responsibilities
Your Work
In this role, you will:
- Lead the valuation process for IBNR reserves, ensuring accuracy and compliance with regulatory requirements. Develop and maintain models to estimate IBNR liabilities and provide insights into reserve adequacy
- Present detailed actuarial reports and presentations to senior management, Board Audit Committee, auditors and regulatory bodies. Act as Appointed Valuation Actuary for California Department of Insurance products
- Lead team to analyze and interpret health care cost trends to support pricing and financial planning. Develop and communicate trend projection assumptions (known as Trendsetters) based on historical data and emerging market trends
- Draw insights from risk score emerging metrics to forecast for multiple lines of business and collaborate with Risk Adjustment operational teams
- Guide actuarial and medical informatic professionals to conduct ad-hoc actuarial analyses to support various business needs, including cost-benefit analyses, financial impact assessments, and strategic decision-making. Provide actionable insights and recommendations based on the analysis.
- Lead a team of actuaries and analysts, foster a collaborative work environment and innovate on new analytical capabilities
- Work closely with cross-functional teams, including pricing, finance, Health Solutions and Risk Adjustment operations to support business objectives
- Monitor current and emerging regulatory pertaining to healthcare cost and risk adjustment, communicate of these developments to relevant stakeholders, and ensure processes and procedures are consistent with changing regulations
- Ensure compliance with all relevant actuarial standards, statue and regulations, and company policies. Identify and mitigate risks associated with actuarial processes and methodologies. Ensure timely tracking of results and course correction activities as needed
Qualifications
Your Knowledge and Experience
- Requires a bachelor's degree in actuarial science, mathematics, statistics, computer science or related field and 12 years prior relevant job including 6 years of management experience
- Requires Director-level knowledge in 2 or more of the following health insurance actuarial functions: reserving, cost of healthcare trend analysis, pricing, population risk scores and cost-benefit analysis
- Requires an ASA however, a Fellow of the Society of Actuaries (FSA) or equivalent professional designation is preferred
- Requires one to meets or will meet US Qualification Standards for signing an NAIC Statement of Actuarial Opinion upon completing applicable continue education requirement
- Requires strong analytical and problem-solving skills, with proficiency in actuarial modeling and data analysis tool
- Requires excellent leadership and team membership abilities
- Requires ability to work effectively in a cross-functional, dynamic environment and drive for actions
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.