Actuarial Svcs Trend & Network Mgr

Blue Cross and Blue Shield of Nebraska•Omaha, NE

About The Position

At Blue Cross and Blue Shield of Nebraska, we are a mission-driven organization dedicated to championing the health and well-being of our members and the communities we serve. Our team is the power behind that promise. And, as the industry rapidly evolves and we seek ways to optimize business processes and customer experiences, there’s no greater time for forward-thinking professionals like you to join us in delivering on it! As a member of Team Blue, you’ll find purpose, opportunities and the support you need to build a meaningful career and make a powerful impact in our community. This role leads the development and oversight of key actuarial functions that support the organization's financial performance and strategic decision-making. This position is responsible for guiding actuarial analyses related to pricing trends, network and area factors, provider performance, Medicare Advantage, forecasting and other healthcare actuarial initiatives.

Requirements

Bachelor's degree in actuarial science, Mathematics, Statistics, or related field.
Five years of experience in an actuarial role and three years of experience in the health care industry.
ASA Licensure/Certification.
An equivalent combination of education and experience may be substituted for this requirement.
The ability to meet or exceed the attendance and timeliness requirements of their departments.
The ability to work well in a team environment and be capable of building and maintaining positive relationships with other staff, departments, and customers.

Nice To Haves

Three (3) years of leadership experience.
Experience leading healthcare actuarial analyses and developing actuarial methodologies.
Strong communication and presentation skills, including the ability to explain complex findings to business and executive leadership.
Experience improving actuarial processes through automation, artificial intelligence, or advanced analytics.

Responsibilities

Manipulate and analyze data using SQL, Databrick and Excel.
Maintain and improve the Pricing Trend methodology, process, and documentation.
Maintain and improve the Network/Area factors methodology, and Provider entity performance analysis and documentation.
Oversee the monthly Medicare Advantage IBNR, Quarterly & Annual Statement, Risk Adjustment analysis and other related projects. Support the Bid process.
Support the corporate reinsurance program, such as renewal, monthly reporting, and filing for reimbursement.
Provide VBC Trend and support other VBC activities.
Manage the Actuarial Services department workflows.
Prepare and present reports to internal management.
Accountable to coach, motivate and provide leadership to direct reports.
Serve on cross functional teams to represent actuarial point of view.