Job Description

Your Role The Cost of Health Care Actuarial team is responsible for supporting the Pharmacy Reimagined strategy in addition to traditional actuarial functions of claim reserves and cost trends. The Pharmacy Actuarial Analyst, Principal will report to the Senior Director, Cost of Health Care Actuarial. In this role you will support the Pharmacy Team’s strategic objectives in contract negotiations, formulary changes, product development, and initiative evaluation. Your Work In this role, you will: Understand the core principles and functionality underlying decision, descriptive, predictive, and prescriptive advanced analytic methods 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 Perform data exploration using a combination of statistical programming languages (including, but not limited R, Python, SQL, SAS) and deploys predictive analytics and machine learning techniques to improve risk prediction, improve reserve, trend and financial forecasting in a manner that is actuarially sound, and enable real-time results and operational efficiencies Lead, coordinate and/or develop strategic, market and competitive analysis Support vendor financial contract performance evaluation, forecast and negotiation (e.g. rebates, network contracts) Support development of budget/trend impact models and formulary strategy models for high impact existing and pipeline drugs Provide actuarial Rx data support and participate in product governance /value assessment committee on Rx benefit and formulary strategy Support ASO product strategy evaluation and coordinate with UW and trendsetter actuary as needed Support RxCare strategic initiatives evaluation as needed Your Knowledge and Experience Requires a bachelor's degree in mathematics, statistics, computer science or equivalent business experience Requires extensive knowledge of job area (including health plan operations) and regulations obtained through professional experience and advanced education Requires an ASA and must be working towards FSA if not complete Requires at least 8 years of professional actuarial experience Requires a mastery level knowledge within the Actuarial job area and may have deeper knowledge of project management Requires experience in working with Pharmacy Benefit Managers Requires experience in pricing for employer group business for Rx discounts/rebates Requires high proficiency in applied statistics skills, such as distributions, statistical testing, regression, etc Requires the ability to program in SQL, SAS and/or Tableau, and experience with common data science toolkits such as R and Python Pay Range: The pay range for this role is: $ 145970.00 to $ 218900.00 for California. Note: Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.

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