Medicare Actuary

Blue Cross Blue Shield Association; Washington (District of Columbia); Sur place; USD 128 000 - 185 000; Plein temps

Avantages offerts par ce poste

Paid time off

11 holidays

Medical/dental/vision insurance

401(k) matching

Résumé du poste

Blue Cross Blue Shield Association in Washington, DC seeks an experienced Medicare Actuary to model and analyze MAPD/PDP EGWP pricing, CMS revenue, and risk adjustment. You will develop actuarial models, lead presentations, and advise management on financial implications of regulatory changes.

A strong background in CMS payment models, RAF/HCC analytics, and ASA/MAAA is required, with the ability to communicate complex actuarial concepts to non-technical audiences.

Qualifications

• Bachelor's degree or equivalent work experience.
• 7+ years actuarial experience in Medicare Advantage/Part D.
• ASA and MAAA certifications required.
• Strong rating, underwriting, forecasting, and financial analysis.
• Ability to communicate complex actuarial concepts to non-technical audiences.
• AI literacy preferred.

Responsabilités

• Model and analyze MAPD/PDP EGWP pricing and benefit design.
• Assess CMS revenue, RAF/HCC analytics, and risk adjustment.
• Develop, implement, and maintain actuarial models and studies.
• Summarize results and communicate recommendations to management.
• Lead actuarial presentations at meetings and conferences.
• Provide technical actuarial support to internal and external customers.

Connaissances

Actuarial expertise

Excel

Communication skills

SQL

R programming

Access

SAS

Visual Basic

Independent judgement

AI literacy

Formation

Bachelor's degree

Outils

SAS

SQL

Visual Basic

R

Access

Excel

Description du poste

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.

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 Actuaries (MAAA)

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 this 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 many 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.