Consulting Actuary – ACA Risk Adjustment

🕒 July 27

🏈 Alabama, Arizona, +21 more states – Remote

🏈 Alabama – Remote 🌵 Arizona – Remote 🐊 Florida – Remote 🥔 Idaho – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🌲 North Carolina – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🚗 Michigan – Remote 🎸 Mississippi – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote ⚔️ Virginia – Remote 🧀 Wisconsin – Remote 🦬 Wyoming – Remote

💵 $143.6k - $229.8k / year

⏰ Full Time

🟠 Senior

🔴 Lead

📊 Actuary

👻 Ghost score 39%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Blue Cross NC

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

Founded 1933

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Blue Cross NC is a health insurance provider that offers a range of health plans and services to individuals and groups. The company focuses on delivering quality healthcare coverage and improving health outcomes for its members through innovative health programs and services. Blue Cross NC is committed to enhancing access to affordable healthcare while supporting the health and wellness of the communities it serves.

📋 Description

• Complete complex actuarial or analytical projects on time and with compliance and quality • Provide strategic thought leadership to improve processes, reduce risks, and meet department and enterprise objectives • Support profitable growth and improve value, quality, and access for Blue Cross NC customers • Achieve segment financial targets and explain results and variances to expectations • Act as a financial steward for the company • Communicate with all organizational levels and divisions, including Divisional Leadership • Manage external partnerships with vendors, auditors, regulators, and health care providers • Negotiate contracts and/or rates • Develop and maintain business relationships with internal partners • Serve as a strategic advisor through business expertise and exceptional support • 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 (FSA) • 7 years of relevant actuarial experience; related experience may be considered • In lieu of an FSA, Associate of the Society of Actuaries (ASA) and at least 9 years of relevant actuarial experience • Meet continuing education standards required for job function, thought leadership, and maintenance of actuarial credentials • At this time, Blue Cross NC will not sponsor employment authorization for this position • 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

🏖️ Benefits

• Medical, dental, and vision coverage • Health and wellness programs • Parental leave and support • Adoption and surrogacy assistance • Career development programs • Tuition reimbursement for continued education • 401k match including an annual company contribution • Annual Incentive Bonus • Paid Time Off (PTO) • Work-life balance, flexibility, and autonomy • Remote work with a few in-office visits each year for meaningful moments