Consulting Actuary - ACA Risk Adjustment
About The Position
As a Consulting Actuary - ACA Risk Adjustment, you will serve as a strategic partner in shaping the financial performance and success of our ACA business. In this highly visible role, you will leverage advanced actuarial expertise, data-driven insights, and market intelligence to influence pricing strategies, risk adjustment performance, product design, and business decisions. Working collaboratively with cross-functional leaders, you will identify opportunities, assess risks, and develop innovative solutions that support organizational goals in an evolving healthcare landscape. This role offers the opportunity to drive meaningful impact while helping advance actuarial excellence across the enterprise.
Requirements
- Bachelor's degree or advanced degree (where required)
- Member of the American Academy of Actuaries
- Fellow of the Society of Actuaries
- 7 years of relevant actuarial experience, related experience may be considered.
- In lieu of an FSA, will consider candidates who are an Associate of the Society of Actuaries (ASA) and have at least 9 years of relevant actuarial experience.
- At this time, Blue Cross NC will not sponsor employment authorization for this position.
Nice To Haves
- Deep experience with ACA Risk Adjustment, including HHS-HCC model methodology, risk score forecasting, and financial impact analysis - Highly Preferred
- Proven expertise in ACA Risk Adjustment transfer forecasting and explanation of results to senior leadership - Highly Preferred
- Strong understanding of diagnosis coding (ICD-10-CM), provider documentation practices, and their impact on risk adjustment outcomes.
- Advanced analytical skills to identify risk adjustment leakage, emerging risks, and optimization opportunities across ACA populations
Responsibilities
- 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
Benefits
- 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
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What This Job Offers
Job Type
Full-time
Career Level
Senior
