Actuarial Svcs Trend & Network Mgr

Blue Cross Blue Shield of Nebraska; Kansas; Hybrid; USD 120,000 - 180,000; Full time

Job summary

Blue Cross and Blue Shield of Nebraska is seeking an experienced actuary to lead and oversee actuarial functions that support financial performance and strategic decision-making. This role is hybrid or remote, with candidates able to reside in eligible states.

The position focuses on analyzing pricing trends, network and area factors, provider performance, Medicare Advantage, forecasting, and related actuarial initiatives while guiding the Actuarial Services department and collaborating with

Qualifications

• Bachelor's degree in actuarial science, Mathematics, Statistics, or related field.
• Five years of experience in an actuarial role and three years in health care.
• ASA Licensure/Certification.

Responsibilities

• Lead development and oversight of key actuarial functions to support financial performance and strategic decisions.
• Analyze pricing trends, network/area factors, and provider performance.
• Oversee Medicare Advantage IBNR, quarterly and annual statements, and risk adjustment analyses.
• Support the bid process and corporate reinsurance program, including renewal and monthly reporting.

Skills

SQL

Excel

Education

Bachelor's degree in actuarial science, Mathematics, Statistics, or related field

Tools

Databrick

Job description

At Blue Cross and Blue Shield of Nebraska, we are a mission-driven organization dedicated to championing the health and well-being of our members and the communities we serve.

Our team is the power behind that promise. And, as the industry rapidly evolves and we seek ways to optimize business processes and customer experiences, there's no greater time for forward-thinking professionals like you to join us in delivering on it! As a member of Team Blue, you'll find purpose, opportunities and the support you need to build a meaningful career and make a powerful impact in our community.

This role leads the development and oversight of key actuarial functions that support the organization's financial performance and strategic decision-making. This position is responsible for guiding actuarial analyses related to pricing trends, network and area factors, provider performance, Medicare Advantage, forecasting and other healthcare actuarial initiatives.

Candidates applying to this position may be hybrid or remote and can live in one of the following states: Florida, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, and Texas.

What you'll do:

• Manipulate and analyze data using SQL, Databrick and Excel.
• Maintain and improve the Pricing Trend methodology, process, and documentation.
• Maintain and improve the Network/Area factors methodology, and Provider entity performance analysis and documentation.
• Oversee the monthly Medicare Advantage IBNR, Quarterly & Annual Statement, Risk Adjustment analysis and other related projects. Support the Bid process.
• Support the corporate reinsurance program, such as renewal, monthly reporting, and filing for reimbursement.
• Provide VBC Trend and support other VBC activities.
• Manage the Actuarial Services department workflows.
• Prepare and present reports to internal management.
• Accountable to coach, motivate and provide leadership to direct reports.
• Serve on cross functional teams to represent actuarial point of view.

To be considered for this position, you must have:

• Bachelor's degree in actuarial science, Mathematics, Statistics, or related field.
• Five years of experience in an actuarial role and three years of experience in the health care industry.
• ASA Licensure/Certification.

An equivalent combination of education and experience may be substituted for this requirement. The ability to meet or exceed the attendance and timeliness requirements of their departments. The ability to work well in a team environment and be capable of building and maintaining positive relationships with other staff, departments, and customers.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Other duties may be assigned.

The strongest candidates for this position will also possess:

• Three (3) years of leadership experience.
• Experience leading healthcare actuarial analyses and developing actuarial methodologies.
• Strong communication and presentation skills, including the ability to explain complex findings to business and executive leadership.
• Experience improving actuarial processes through automation, artificial intelligence, or advanced analytics.

Learn more about what makes BCBSNE such an exceptional place to work by visiting NebraskaBlue.com/Careers.

We strongly believe that diversity of experience, perspective and background will lead to a better workplace for our employees and a better product for our customers and members.