Senior Medicare Actuary - MAPD/PDP Pricing & Risk

001_BCBSA Blue Cross and Blue Shield Association; Chicago, Washington (IL, District of Columbia); On-site; USD 128,000 - 185,000; Full time

Benefits offered by this job

Paid time off

11 holidays

Health/dental/vision insurance

401(k) matching

Lifestyle spending account

Job summary

Blue Cross Blue Shield Association (BCBSA) seeks an experienced Medicare Actuary to perform modeling and analysis for MAPD/PDP EGWP, focusing on pricing, benefit design, CMS revenue, and risk adjustment. The role involves developing models, forecasting, and communicating actuarial insights to support management decisions.

The candidate will lead initiatives evaluating regulatory changes, assist with reserving, experience monitoring, and bid development for Medicare Advantage and Part D,

Qualifications

• Bachelor's Degree or equivalent work experience.
• 7+ years actuarial experience, Medicare Advantage/Part D or related health insurance experience.

Responsibilities

• Modeling, pricing, forecasting, and reserving for MAPD/PDP EGWP programs.
• Analyze CMS revenue, risk adjustment, and benefit design impacts.
• Develop and maintain actuarial models and studies supporting management decisions.
• Present findings and recommendations to leadership and external stakeholders.

Skills

CMS knowledge

RAF/HCC analytics

Actuarial modeling

MS Excel

SQL/SAS/R

Education

Bachelor's degree

Tools

SAS

SQL

R

Visual Basic

Access

Job description

Blue Cross Blue Shield Association (BCBSA) seeks an experienced Medicare Actuary to perform modeling and analysis for MAPD/PDP EGWP, focusing on pricing, benefit design, CMS revenue, and risk adjustment. The role involves developing models, forecasting, and communicating actuarial insights to support management decisions.

The candidate will lead initiatives evaluating regulatory changes, assist with reserving, experience monitoring, and bid development for Medicare Advantage and Part D,