Medicare Actuary

Blue Cross and Blue Shield Association•Chicago, WA

1d•Hybrid

About The Position

The Medicare Actuary performs modeling and analysis for the Federal Employee Program Medicare Advantage and Part D Employer Group Waiver Program (MAPD/PDP EGWP). The role works independently and primarily focuses on EGWP pricing, benefit design, CMS revenue, and risk adjustment. It evaluates the financial implications of program and regulatory changes and supports reserving, forecasting, and experience monitoring. The position serves as a subject matter expert on Medicare Advantage, Part D, and EGWP financial matters. The actuary develops, manages, evaluates, implements, and maintains models and studies using actuarial principles for pricing, underwriting, reserving, trend analyses, rating support, forecasting, and other actuarial functions. The role summarizes results, shares observations, and communicates recommendations to support management decisions. It leads analysis of new initiatives and environmental changes, estimates their financial and actuarial effects, and develops and implements appropriate solutions. The actuary also responds to technical inquiries and provides actuarial support to internal and external customers, including OPM, CMS, Congress, and Blue Plans upon request. The position leads and evaluates Plan Trend Surveys and other BCBSA publications as requested, and leads actuarial presentations at meetings, conferences, and training sessions. It maintains actuarial credentials, which may include continued progression through the actuarial examination process.

Requirements

Bachelor's degree or equivalent work experience.
At least 7 years of actuarial experience, with multiple years in Medicare Advantage/Part D, medical, dental, and/or vision insurance, or other health-related experience.
Substantial health actuarial and related technical expertise in rating, underwriting, valuation, product development, trend analysis, forecasting, rate filings, financial statements, legislative analysis, policy development, and R&D projects.
General understanding of data support systems and data requirements.
Ability to work effectively in a multidisciplinary team environment.
Excellent oral and written communication skills, effective presentation skills in formal and informal settings, and ability to present technical information to non-technical audiences.
Demonstrated technical skills with Microsoft Office, including Microsoft Excel.
Skills in basic accounting and financial analysis.
Experience with Access, SAS, SQL, Visual Basic, R, or other programming skills.
Ability to exercise independent actuarial judgment.
Required Associate of the Society of Actuaries (ASA) credential.
Required membership in the American Academy of Actuaries (MAAA).

Nice To Haves

AI literacy and understanding of generative AI tools, including appropriate business applications and limitations.

Responsibilities

Develop, manage, evaluate, implement, and maintain actuarial models and studies for pricing, underwriting, reserving, trend analyses, rating support, forecasting, and other actuarial functions.
Analyze EGWP pricing, benefit design, CMS revenue, and risk adjustment, and evaluate the financial implications of program and regulatory changes.
Support reserving, forecasting, and experience monitoring.
Summarize results, provide observations, and communicate recommendations to support management decisions.
Lead analysis and quantify the effects of new initiatives and environmental changes, including laws and regulations, tax policy, trends, and competitor, member, and provider behavior.
Analyze financial effects, determine estimated actuarial impacts, and develop and implement appropriate solutions.
Respond to technical inquiries and provide actuarial support to internal and external customers, including OPM, CMS, Congress, and Blue Plans upon request.
Lead and evaluate Plan Trend Surveys and other BCBSA publications as requested.
Lead actuarial presentations at meetings, conferences, and training sessions as requested.
Maintain actuarial credentials, which may include continued progression through the actuarial examination process.