Consulting Actuary - ACA Risk Adjustment

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

Benefits offered by this job

Medical, dental, and vision coverage

401k with company match

Tuition reimbursement

Job summary

Blue Cross NC is seeking a Consulting Actuary to lead ACA risk adjustment initiatives, pricing strategies, and advanced care management analyses. You will benchmark competitors, forecast risk scores, and drive opportunities for profitable growth while maintaining actuarial excellence.

You’ll collaborate with internal divisions and external partners to deliver actionable insights and strategic recommendations, while upholding continuing education and professional standards.

Qualifications

• Bachelor’s degree or higher in a relevant field.
• AA actuarial credential(s) required; FSA preferred.
• 7+ years of actuarial experience in risk adjustment or healthcare.

Responsibilities

• Lead actuarial initiatives and pricing for business segments.
• Analyze ACA risk adjustment models and forecast risk scores.
• Benchmark competitive performance and optimize financial impact.
• Communicate results clearly to senior leadership and partners.
• Manage external partnerships with vendors, regulators, and providers.
• Build strong internal relationships and act as advisor.

Skills

Actuarial analysis

Leadership

Stakeholder communication

ACA risk adjustment

Education

Bachelor’s degree or advanced degree

Member of the American Academy of Actuaries

Fellow of the Society of Actuaries

7 years of actuarial experience

Job description

Job Description

As a Consulting Actuary -ACA Risk Adjustment, you will play a pivotal role in delivering a wide array of actuarial and analytical services for our organization. Responsibilities include leading pricing strategies and actuarial initiatives for business segments, evaluating advanced care management models, conducting competitive benchmarking analyses, and designing and pricing sophisticated insurance products. You will support company objectives by providing reliable, actionable actuarial insights and recommendations, proactively identifying and addressing complex risks and opportunities. This position requires adaptability to the evolving landscape of the industry, ensuring our actuarial practices remain at the forefront of innovation and excellence.

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.

Bonus Points

• Deep experience with ACA Risk Adjustment , including HHS-HCC model methodology, risk score forecasting, and financial impact analysis - Highly Preferred

• P roven 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

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

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