Consulting Actuary - ACA Risk Adjustment

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

Benefits offered by this job

Medical, dental, and vision coverage

Parental leave

Tuition reimbursement

401k match

Job summary

Blue Cross and Blue Shield of North Carolina is seeking an experienced actuary to lead complex actuarial projects, ensuring timeliness, compliance, and high-quality outputs.

The role requires strategic leadership to improve processes, manage risks, and support profitable growth while enhancing value, quality, and access for Blue Cross NC customers. Collaboration with leadership and external partners is essential.

Qualifications

• Bachelor's degree or advanced degree required.
• Member of the American Academy of Actuaries Fellow of the Society of Actuaries.
• 7+ years of actuarial experience; ASA/FSA considered with related experience.
• Blue Cross NC will not sponsor employment authorization.

Responsibilities

• Complete complex actuarial or analytical projects on time and with quality.
• Provide strategic leadership to improve processes, reduce risks, and drive enterprise objectives.
• Explain segment financial performance and variances; act as a financial steward.
• Communicate effectively with leadership and divisions across the organization.
• Manage external partnerships with vendors, auditors, regulators, and providers; negotiate contracts/rates.
• Develop strong business relationships with internal partners and act as a strategic advisor.
• Meet continuing education standards required for actuarial credentials.

Skills

Actuarial Analysis

Actuarial Management

Regulatory Compliance

ACA Risk Adjustment

Education

Bachelor's degree

ASA/FSA

Job description

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'll 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.

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

About Us

It's an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Health care is changing, and we're leading the way. We offer more than health insurance our customers can count on. We're committed to better health and better health care - in our communities and beyond. Our employees bring energy and creativity to the workplace, and it shows in our innovative approach to improving the health and well‑being of North Carolinians. Blue Cross NC is a fully taxed, not-for-profit company headquartered in Durham, North Carolina. We serve more than 4.3 million members, and we employ more than 5,000 people across the country who are passionate about making health care better for all. Help us lead the charge for better health care by joining our award‑winning team. Discover tremendous opportunities with us to do challenging and rewarding work. Opportunities that can lead you to a fulfilling career, work that can help others lead healthier, happier lives.

Authorization to Work in the United States

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Request Accommodations

Blue Cross NC provides reasonable accommodations to applicants with disabilities. If you need a reasonable accommodation for any part of the application, hiring process, or have technical issues that prevent you from completing your application please notify HR at [e-mail].