Consulting Actuary - ACA Risk Adjustment

Blue Cross and Blue Shield of North Carolina; Indiana; Hybrid; USD 144,000 - 230,000; Full time

Benefits offered by this job

Annual Incentive Bonus

401(k) with employer match

Paid Time Off

Health, dental, and vision benefits

Tuition reimbursement

Job summary

Blue Cross NC is seeking a Consulting Actuary - ACA Risk Adjustment to partner on pricing strategies, risk adjustment performance, product design and strategic decisions. You will leverage actuarial expertise, data insights, and market intelligence to influence outcomes across the ACA portfolio.

This high-visibility role requires collaboration with cross-functional leaders, strong communication with executives, and the ability to translate complex analyses into actionable plans while upholding

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; ASA with 9+ years considered.

Responsibilities

• Complete complex actuarial or analytical projects on time and with quality.
• Provide strategic leadership to improve processes, reduce risks and drive profitable growth.
• Explain results and variances to executives; act as financial steward.
• Communicate with leadership and divisions; maintain strong internal partnerships.
• Manage external partnerships, including negotiations with vendors and regulators.
• Build and maintain relationships; act as a strategic advisor.
• Meet continuing education requirements for professional credentials.

Skills

Actuarial experience

Stakeholder communication

Education

Bachelor's degree or advanced degree

Member of the American Academy of Actuaries

Fellow of the Society of Actuaries

Associate of the Society of Actuaries (ASA)

Job description

Job Description

As a Consulting Actuary - ACA Risk Adjustment, you will serve as a strategic partner in shaping the financial performance and success of our ACA business. In this highly visible role, you will leverage advanced actuarial expertise, data-driven insights, and market intelligence to influence pricing strategies, risk adjustment performance, product design, and business decisions. Working collaboratively with cross-functional leaders, you will identify opportunities, assess risks, and develop innovative solutions that support organizational goals in an evolving healthcare landscape. This role offers the opportunity to drive meaningful impact while helping advance actuarial excellence across the enterprise.

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 of ways to improve processes, reduce risks, and meet department and enterprise objectives to achieve profitable growth and/or improve value, quality, and access for Blue Cross NC customers
• Achieve segment financial targets and provide concise explanations of results and variances to expectations; act as a financial steward for the company
• Communicate effectively with all levels and divisions within the organization, including Divisional Leadership
• Manage external partnerships with vendors, auditors, regulators, and health care providers, including effective negotiation of contracts and/or rates
• Develop and maintain strong business relationships with internal partners through business expertise and exceptional support; act as a strategic advisor
• Meet continuing education standards required for job function, thought leadership and maintenance of actuarial credentials

What You Bring

• 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) and have at least 9 years of relevant actuarial experience.

At this time, Blue Cross NC will not sponsor employment authorization for this position.

Bonus Points

• 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

What You’ll Get

• 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

WhereYou’llWork

Our Hybrid Flex approach is builton presencewith a purpose – giving you flexibility to work remotely with intentional in-person connection – that supports a workplacethat’sflexible, connected, and future focused.

In a Hybrid-Flex role,you’llwork in the office at least two days a week for collaboration and connection. In a Remote Flex role,you’llwork virtually, with a few in-office visits each year formeaningfulmoments that matter.

Whether your role is Hybrid Flex or Remote Flex depends on the nature of the work and distance from our Durham headquarters. We welcome candidates from outside the local area and in anystateslistedonthis job posting. Onsite expectations will be discussed during the interview process.

Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and 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.

$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