Consulting Actuary - ACA Risk Adjustment

Job Description

As a Consulting Actuary -ACA Risk Adjustment, you will play a pivotal role in delivering a wide array of actuarial and analytical services for our organization. Responsibilities include leading pricing strategies and actuarial initiatives for business segments, evaluating advanced care management models, conducting competitive benchmarking analyses, and designing and pricing sophisticated insurance products. You will support company objectives by providing reliable, actionable actuarial insights and recommendations, proactively identifying and addressing complex risks and opportunities. This position requires adaptability to the evolving landscape of the industry, ensuring our actuarial practices remain at the forefront of innovation and excellence.

What You’ll Do

• 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

What You Bring

• 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.

Bonus Points

• Deep experience with ACA Risk Adjustment , including HHS-HCC model methodology, risk score forecasting, and financial impact analysis - Highly Preferred

• P roven 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

What You’ll Get

• The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community.

• Work-life balance, flexibility, and the autonomy to do great work.

• 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 

• Learn more (

Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.

*Based on annual corporate goal achievement and individual performance.

$143,616.00 - $229,786.00

Skills

Actuarial Analysis, Actuarial Management, Actuarial Science, Actuarial Services, Affordable Care Act (ACA), Complex Care Management, Financial Reporting and Analysis, Hiring Management, Insurance Industry, Organizational Leadership, Regulatory Compliance

JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published on . If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: View email address on click.appcast.io .

About Us

It's an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Health care is changing, and we're leading the way. We offer more than health insurance our customers can count on. We’re committed to better health and better health care − in our communities and beyond. Our employees bring energy and creativity to the workplace, and it shows in our innovative approach to improving the health and well-being of North Carolinians.

Blue Cross NC is a fully taxed, not-for-profit company headquartered in Durham, North Carolina. We serve more than 4.3 million members, and we employ more than 5,000 people across the country who are passionate about making health care better for all.

Help us lead the charge for better health care by joining our award-winning team. Discover tremendous opportunities with us to do challenging and rewarding work. Opportunities that can lead you to a fulfilling career, work that can help others lead healthier, happier lives.

Authorization to Work in the United States

We use E-verify to confirm authorization to work in the United States. To learn more about E-Verify, including your rights and responsibilities, please visit E-Verify Overview ( for English or Visión General de E-Verify ( for Español.

Request Accommodations

Blue Cross NC provides reasonable accommodations to applicants with disabilities. If you need a reasonable accommodation for any part of the application or hiring process, please notify HR at View email address on click.appcast.io .

Blue Cross NC is a Hybrid Flex company. Whether the role is Hybrid Flex or Remote Flex depends on the nature of the work and distance from our Durham headquarters. We welcome candidates from outside the local area and in any of our approved states:

Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming