Consulting Actuary - Medicare Risk Adjustment

Blue Cross and Blue Shield of North Carolina; Pennsylvania; On-site; USD 117,000 - 223,000; Full time

Job summary

A healthcare organization is seeking a Consulting Actuary to shape the future of care delivery through data-driven insights and strategic actuarial expertise. In this role, you'll lead initiatives impacting patient outcomes and business performance, while managing external partnerships and providing thought leadership. The ideal candidate has relevant actuarial experience, strong analytical skills, and a commitment to improving healthcare affordability and quality. Competitive compensation and benefits are offered.

Benefits

Medical, dental, and vision coverage

401k match including an annual company contribution

Career development programs and tuition reimbursement

Qualifications

• 7 years of relevant actuarial experience, related experience may be considered.
• In lieu of an FSA, will consider candidates who are ASA and have at least 9 years of relevant actuarial experience.

Responsibilities

• Accountable for completion of complex actuarial or analytical projects.
• Provide proactive and strategic thought leadership to improve processes and meet objectives.
• Achieve segment financial targets and provide concise explanations of results.
• Manage external partnerships with vendors, auditors, regulators, and health care providers.
• Develop and maintain strong business relationships with internal partners.

Skills

Actuarial Analysis

Actuarial Management

Financial Reporting and Analysis

Regulatory Compliance

Education

Bachelor's degree or advanced degree

Member of the American Academy of Actuaries

Fellow of the Society of Actuaries

Job description

Job Description

As a Consulting Actuary at our healthcare organization, you will play a pivotal role in shaping the future of care delivery through data-driven insights and strategic actuarial expertise. You'll lead initiatives that directly impact patient outcomes and business performance—whether it's designing innovative insurance products, optimizing pricing strategies, or evaluating advanced care management models.

Your work will support key organizational goals by delivering clear, consistent, and actionable analysis that informs executive decision-making. You'll also conduct competitive benchmarking and identify emerging risks and opportunities in a rapidly evolving healthcare landscape.

This role is ideal for a forward-thinking actuary who thrives in a dynamic environment and is passionate about using their skills to improve healthcare affordability, accessibility, and quality.

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

• Experience in Medicare Advantage Risk Adjustment highly preferred

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

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.

Salary range: $117,200.00 - $222,500.00. Based on annual corporate goal achievement and individual performance.

Skills

Actuarial Analysis, Actuarial Management, Actuarial Science, Actuarial Services, Complex Care Management, Financial Reporting and Analysis, Hiring Management, Insurance Industry, Organizational Leadership, Regulatory Compliance