Consulting Actuary - ACA Risk Adjustment

Blue Cross NC; North Carolina; Ibrido; USD 150.000 - 230.000; Tempo pieno

Vantaggi offerti da questo lavoro

Medical, dental, vision coverage

401k match

Descrizione del lavoro

Blue Cross NC is seeking an experienced Consulting Actuary for ACA Risk Adjustment. This senior role partners across the enterprise to shape pricing strategies, risk adjustment performance, product design, and strategic decisions.

It involves leading complex actuarial projects, stakeholder communication, and strategic advisory work to drive profitability and value for Blue Cross NC customers. The position emphasizes ACA risk adjustment expertise, transfer forecasting, ICD-10-CM understanding,

Competenze

• Minimum 7 years of actuarial experience or related experience.

Mansioni

• Accountable for completion of complex actuarial or analytical projects, ensuring timeliness, compliance, and quality of work.

Descrizione del lavoro

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
• Learn more

Where You’ll Work

Our Hybrid Flex approach is built on presence with a purpose – giving you flexibility to work remotely with intentional in-person connection – that supports a workplace that’s flexible, connected, and future focused.

In a Hybrid-Flex role, you’ll work in the office at least two days a week for collaboration and connection. In a Remote Flex role, you’ll work virtually, with a few in-office visits each year for meaningful moments 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 any states listed on this job posting. Onsite expectations will be discussed during the interview process.