Principal Actuary, Cost of Care

Blue Cross and Blue Shield of North Carolina; Wyoming (OH); On-site; USD 119,000 - 190,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

401k match

PTO and tuition reimbursement

Job summary

Blue Cross NC is seeking a Principal Actuary to deliver a broad range of actuarial and analytical work, including pricing strategy for multiple business segments and evaluating care management models. This role focuses on performance evaluations across Cost of Care initiatives and proposed programs across clinical, pharmacy, network, and value-based care areas.

You will lead complex projects, communicate with leadership, manage external partnerships, and drive actionable insights to support

Qualifications

• Bachelor's degree or advanced degree in a related field.
• ASA designation (FSA preferred); exam takers may be considered based on experience.
• 5+ years of actuarial experience relevant to pricing, strategy, and risk.

Responsibilities

• Lead complex actuarial projects ensuring timeliness and quality.
• Provide strategic leadership to improve processes and profitability.
• Meet segment financial targets and explain results clearly.
• Communicate with Divisional Leadership and other stakeholders.
• Manage external partnerships with vendors, auditors, regulators, and providers.
• Build strong internal partnerships as a strategic advisor.
• Maintain continuing education to meet credential requirements.
• Develop measurement models for cost-savings initiatives across clinical and network areas.

Skills

Actuarial analysis

Strategic leadership

Stakeholder communication

Education

Bachelor's degree

ASA designation

Advanced degree

Tools

SQL

Power BI

Tableau

Job description

Job Description

The Principal Actuary delivers a broad range of actuarial or analytical work for the company, such as conducting pricing and actuarial strategy for a business segment, evaluating advanced care management models, performing competitive benchmarking analysis, and conducting economic value evaluation of cost containment initiatives. They support the company strategy by providing sound, consistent, and actionable actuarial analysis and recommendations, and can identify and react to nuanced risks and opportunities. This particular role will focus on performance evaluations for both existing initiatives within the Cost of Care portfolio and newly proposed initiatives across several different subject areas including clinical, pharmacy, network, payment integrity, value-based care, and more.

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.




• Develop measurement models for various cost savings initiatives across the company's many strategic areas including, but not limited to clinical care management, alternative payment arrangements with providers, medical coding and policy adherence practices, and other emerging drivers of trend.

What You Bring

• Bachelor's degree or advanced degree in related field




• ASA designation (FSA preferred); exam takers may be considered based on other experience




• 5+ years of relevant actuarial experience, related experience may be considered.

Bonus Points

• SQL-based data queries and data management




• Experience with data visualization applications such as Power-BI and Tableau




• Experience creating and presenting external, client-facing materials and reports.

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.

$118,691.00 - $189,906.00