Assistant Actuary I - (Medicare Part D)

Independence Blue Cross; Philadelphia (Philadelphia County); Hybrid; USD 140,000 - 200,000; Full time

Benefits offered by this job

Hybrid work model

Tri-State area office

Job summary

A healthcare company is seeking a Senior Actuary to join their Government Markets team in Philadelphia. The ideal candidate will focus on Medicare Part D pricing, owning the design and development of pricing models, forecasting, and strategic decision-making. A Bachelor's degree in Actuarial Science, 6+ years of actuarial experience, and ASA designation are required. This role follows a hybrid work model, requiring on-site work three days a week and remote work for two days.

Qualifications

• 6+ years of actuarial experience with focus on Medicare Part D pricing or pharmacy analytics.
• Demonstrated experience in building and validating actuarial models.
• Strong experience with detailed healthcare claims data.
• Experience working with detailed healthcare claims data.
• Proficiency in Excel and SQL; R/SAS skills preferred.

Responsibilities

• Own design, development, and maintenance of Part D pricing models.
• Translate complex Part D benefit designs into model logic.
• Lead reconciliation of model results to financial forecasts.
• Establish modeling standards and validation frameworks.
• Monitor regulatory developments and assess financial implications.
• Present modeling results to actuarial leadership and management.

Skills

Medicare Part D pricing

Excel

SQL

R

SAS

Healthcare claims data

Communication skills

Education

Bachelor’s degree in Actuarial Science, Mathematics, Statistics, or related field

Associate of the Society of Actuaries (ASA) designation

Tools

Excel

SQL

R

SAS

Job description

Bring your drive for excellence, teamwork, and customer commitment to Independence. Join us as we renew and reimagine the future of health care. Together, we will achieve our mission to enhance the health and well‑being of the people and communities we serve.

We are seeking a senior actuary with deep experience in Medicare Part D pricing to join our Government Markets team. This role will have responsibility for the design, development, and ongoing ownership of Part D pricing models, including member‑level projections used for forecasting and strategic decision making. Ideal candidates will have hands‑on experience with Medicare Part D bid development or prior pharmacy experience.

Key Responsibilities

• Own end‑to‑end design, development, and maintenance of Part D pricing models to project member‑level drug utilization, cost sharing, plan liability, and CMS payments.
• Translate complex Part D benefit designs, formularies, and CMS rules into robust model logic.
• Lead reconciliation of seriatim model results to aggregate bid components, financial forecasts, and statutory reporting.
• Establish modeling standards, validation frameworks, and documentation practices to ensure accuracy and transparency.
• Provide expert judgment on key pricing assumptions, trends, and emerging risks impacting Part D financial performance.
• Lead scenario analysis and strategic modeling (e.g., benefit redesigns, formulary changes, trend, risk mix, regulatory changes, customer level pricing) using seriatim projections.
• Partner closely with finance, pharmacy, underwriting, product, and strategy teams to inform pricing decisions and corporate forecasts.
• Monitor regulatory developments and CMS guidance, assess financial implications, and recommend pricing or strategy responses.
• Present complex modeling results and recommendations to actuarial leadership and senior management.
• Bachelor’s degree in Actuarial Science, Mathematics, Statistics, or a related field.
• 6+ years of actuarial experience, with significant focus on Medicare Part D pricing or pharmacy analytics.
• Associate of the Society of Actuaries (ASA) designation.
• Demonstrated experience building, owning, and validating complex actuarial models.
• Strong experience working with detailed healthcare claims data.
• Proficiency in Excel and SQL; experience with R, SAS, or similar tools strongly preferred.
• Strong communication skills, with the ability to translate technical results into clear business insights.

Preferred Experience

• Direct ownership of Part D bid pricing models or major bid components.
• Experience leading or reviewing seriatim or claim‑level actuarial models.
• Demonstrated ability to exercise actuarial judgment in ambiguous or evolving regulatory environments.
• Experience influencing pricing or strategy decisions through data‑driven analysis.
• Proven ability to manage multiple high‑impact priorities in a deadline‑driven environment.

Independence has implemented a “Hybrid” model which consists of Associates working in the office 3 days a week (Tuesday, Wednesday & Thursday) and remotely 2 days a week (Monday & Friday). This role is designated as a role that fits into the “Hybrid” model. While associates may work remotely on our designated remote days, the work must be performed in the Tri‑State Area of Delaware, New Jersey, or Pennsylvania.

Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.

IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.