Medicare Actuary - EGWP Pricing & MA-PD Analytics

Blue Cross Blue Shield Association; Washington (District of Columbia); On-site; USD 128,000 - 185,000; Full time

Benefits offered by this job

Paid time off

11 holidays

Medical/dental/vision insurance

401(k) matching

Job summary

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.

Responsibilities

• 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.

Skills

Actuarial expertise

Excel

Communication skills

SQL

R programming

Access

SAS

Visual Basic

Independent judgement

AI literacy

Education

Bachelor's degree

Tools

SAS

SQL

Visual Basic

R

Access

Excel

Job description

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.