[Hiring] Consulting Actuary @Blue Cross and Blue Shield of North Carolina

Role Description

As a Consulting Actuary - ACA Risk Adjustment, you will play a pivotal role in delivering a wide array of actuarial and analytical services for our organization. Responsibilities include:

• Leading pricing strategies and actuarial initiatives for business segments.
• Evaluating advanced care management models.
• Conducting competitive benchmarking analyses.
• Designing and pricing sophisticated insurance products.
• Providing reliable, actionable actuarial insights and recommendations.
• Proactively identifying and addressing complex risks and opportunities.
• Ensuring our actuarial practices remain at the forefront of innovation and excellence.

What You’ll Do:

• Accountable for completion of complex actuarial or analytical projects, ensuring timeliness, compliance, and quality of work.
• Provide proactive and strategic thought leadership to improve processes, reduce risks, and meet department and enterprise objectives.
• Achieve segment financial targets and provide concise explanations of results and variances to expectations.
• Communicate effectively with all levels and divisions within the organization, including Divisional Leadership.
• Manage external partnerships with vendors, auditors, regulators, and health care providers.
• Develop and maintain strong business relationships with internal partners.
• Meet continuing education standards required for job function and maintenance of actuarial credentials.

Qualifications

• Bachelor's degree or advanced degree (where required).
• Member of the American Academy of Actuaries.
• Fellow of the Society of Actuaries.
• 7 years of relevant actuarial experience; related experience may be considered.
• In lieu of an FSA, will consider candidates who are an Associate of the Society of Actuaries (ASA) with at least 9 years of relevant actuarial experience.

Requirements

• Deep experience with ACA Risk Adjustment, including HHS-HCC model methodology, risk score forecasting, and financial impact analysis - Highly Preferred.
• Proven expertise in ACA Risk Adjustment transfer forecasting and explanation of results to senior leadership - Highly Preferred.
• Strong understanding of diagnosis coding (ICD-10-CM), provider documentation practices, and their impact on risk adjustment outcomes.
• Advanced analytical skills to identify risk adjustment leakage, emerging risks, and optimization opportunities across ACA populations.

Benefits

• The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community.
• Work-life balance, flexibility, and the autonomy to do great work.
• Medical, dental, and vision coverage along with numerous health and wellness programs.
• Parental leave and support plus adoption and surrogacy assistance.
• Career development programs and tuition reimbursement for continued education.
• 401k match including an annual company contribution.

Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price. Our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications, and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.

*Based on annual corporate goal achievement and individual performance.

Salary Range: $143,616.00 - $229,786.00

Skills

• Actuarial Analysis
• Actuarial Management
• Actuarial Science
• Actuarial Services
• Affordable Care Act (ACA)
• Complex Care Management
• Financial Reporting and Analysis
• Hiring Management
• Insurance Industry
• Organizational Leadership
• Regulatory Compliance