Medicare Actuary

Blue Cross Blue Shield Association; United States; Hybrid; USD 128,000 - 185,000; Full time

Benefits offered by this job

Annual bonus eligibility

Job summary

The Blue Cross Blue Shield Association is seeking an experienced Medicare Actuary to perform complex modeling and analysis for the MAPD/PDP EGWP programs. The role focuses on EGWP pricing, benefit design, CMS revenue, and risk adjustment, with responsibilities in reserving, forecasting, and experience monitoring.

Ideal candidates will have CMS payment model expertise, RAF/HCC analytics, and Medicare Advantage/Part D bid development experience, serving as a subject matter expert on related

Qualifications

• Bachelor's degree or equivalent work experience.
• 7+ years actuarial experience, with Medicare Advantage/Part D or related health insurance experience.
• Expertise in rating, underwriting, reserving, trend analysis, forecasting, and rate filings.

Responsibilities

• Modeling and analysis for MAPD/PDP EGWP pricing, benefit design, CMS revenue, and risk adjustment.
• Develop, maintain, and evaluate actuarial models for pricing, forecasting, and financial statements.
• Lead and communicate technical results to management and stakeholders.

Skills

Actuarial analysis

CMS payment models

RAF & HCC analytics

Excel

Presentation skills

Education

Bachelor's degree or equivalent

ASA - SOA

MAAA membership

Tools

SAS

SQL

Visual Basic

R

Access

Job description

We are seeking an experienced Medicare Actuary to perform modeling and analysis for the Federal Employee Program Medicare Advantage and Part D Employer Group Waiver Program (MAPD/PDP EGWP). This role works independently primarily focusing on EGWP pricing, benefit design, CMS revenue, and risk adjustment, evaluating the financial implications of program and regulatory changes while supporting reserving, forecasting, and experience monitoring. The ideal candidate brings expertise in CMS payment models, RAF and HCC analytics, and Medicare Advantage/Part D bid development, serving as the subject matter expert on Medicare Advantage, Part D, and EGWP financial matters.

Develops, manages, and provides the evaluation, implementation, and maintenance of models and studies, which use actuarial principles for the purposes of pricing, underwriting, reserving, trend analyses, rating support, forecasting, and other actuarial functions as needed. Summarizes results, provides observations, and communicates recommendations to support management decisions.

Leads, develops, analyzes, and quantifies the effects of new initiatives, proposals, environmental changes such as: laws/regulation, tax policy; trend; competitor, member, and provider behavior impacting FEP, BCBSA, or Blue Plans, as appropriate. Analyzes the financial effect and determines the estimated actuarial impact as well as develops and implements appropriate solutions.

Responds to a variety of technical inquiries or requests and provides technical actuarial support to internal customers or external customers (OPM, CMS, Congress, etc.), and Blue Plans upon request. Leads and evaluates the Plan Trend Surveys and other BCBSA publications as requested.

Leading actuarial presentations at meetings, conferences, and training sessions as requested.
Maintains actuarial credentials which may include continued progression through the actuarial examination process.

The posting range for this position is:

127,500.00 - 184,875.00

Qualifications:

Education

• - Required Bachelor's Degree or equivalent work experience

Experience

• - Required 7+ Years actuarial experience, with multiple years in Medicare Advantage/Part D, medical, dental, and/or vision insurance, or other health related experience.

Knowledge Skills and Abilities

• - Substantial health actuarial and related technical expertise in rating, underwriting, valuation, product development, trend analysis, forecasting, rate filings, financial statements, legislative analysis, policy development, and R&D projects is required.
• - General understanding of data support systems and data requirements.
• - Ability to work effectively in multi-disciplinary team environment.
• - Excellent oral and written communication skills, as well as effective presentation skills in both formal and informal settings with the ability to present technical information to non-technical audiences
• - Demonstrated technical skills with the Microsoft Office Suite are required, including Microsoft Excel.
• - Skilled in basic accounting and financial analysis.
• - Experience in Access, SAS, SQL, Visual Basic, R, or other programming skills.
• - Ability to exercise independent actuarial judgement
• - Preferred: Demonstrates AI literacy and an understanding of generative AI tools, including appropriate business applications and limitations.

Certifications & Licenses

• - Required: Associate of the Society of Actuaries (ASA) - SOA
• - Required: Financial Services\\Membership in the American Academy of Actuators (MAAA)

#LI-Hybrid

The posted salary range is the lowest to highest salary we , in good faith , believe we would pay for this role at the time of this posting . We may ultimately pay more or less than the hiring range and t his hiring range may also be modified in the future. A candidate’s position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs. This job is also eligible for annual bonus incentive pay.

We offer a comprehensive package of benefits including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching , lifestyle spending account and m any other benefits to eligible employees.

Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.