Lead Actuary - Pharmacy Benefit Management

Job Description Join our dynamic Pharmacy Analytics team as a Lead Actuary and play a pivotal role in shaping the future of our pharmacy benefits. In this highly prominent position, you will provide essential actuarial oversight for our Pharmacy Benefit Manager (PBM). Your expertise will help us translate complex contractual requirements into actionable financial models, develop innovative PBM arrangements, and deliver value through rigorous analytics. Collaborate closely with our internal pharmacy leadership and external partners to ensure we maintain a competitive edge in a rapidly evolving marketplace. What You'll Do PBM Contract Modeling & Oversight: Transform intricate PBM contractual terms into solid financial and actuarial models, ensuring that all requirements are met or surpassed. Strategic Initiatives: Take the lead in establishing and implementing new, intricate PBM arrangements. Rebate & Financial Reconciliation: Conduct thorough PBM rebate reconciliations to maintain accuracy in financial forecasting and payment precision. Analytics & Forecasting: Create and sustain advanced models for rebate forecasting, pharmacy cost trend analysis, and savings identification. Strategic Collaboration: Partner with key stakeholders (Pharmacy Operations, Finance, Legal) to align pharmacy strategy with broader health plan objectives. Industry Leadership: Track industry trends, regulatory updates, and competitive developments to preserve our market position. Mentorship: Provide guidance and support to junior actuarial staff, fostering their development in pharmacy financial expertise. What You Bring Bachelor's degree or advanced degree as applicable. Associate of the Society of Actuaries (ASA) and Member of the American Academy of Actuaries (MAAA). 5+ years of relevant experience. Alternately, candidates with Fellowship of the Society of Actuaries (FSA) may be considered. Bonus Points Experience in PBM contract negotiations, GPOs, 340B, Pharmacy Network Contracting, and/or Pharmacy Rebate Contracting - Highly Preferred. Familiarity with Specialty Pharmacy modeling. Strong communication skills, able to convey complex financial/actuarial information to non-technical audiences and senior leadership. Proficient in building relationships and effectively collaborating with internal and external partners - Highly Preferred. Expertise in SAS, SQL, and advanced Excel - Highly Preferred. Experience in constructing complex financial models. Exceptional analytical and creative problem-solving abilities. Ability to thrive in a team-oriented, collaborative environment. Self-driven, resourceful, and capable of working independently in a fast-paced, high-growth setting. What You'll Get The chance to contribute to pioneering healthcare delivery with a committed team. Flexible work-life balance and the autonomy to excel in your role. Comprehensive medical, dental, and vision coverage along with various health and wellness initiatives. Parental leave support, as well as assistance for adoption and surrogacy. Opportunities for career development and tuition reimbursement for ongoing education. A 401k plan with company matching, including annual contributions. Salary Range At Blue Cross NC, we are dedicated to offering a fair and competitive compensation package that reflects market rates. Our starting salaries are generally positioned near the midpoint of the provided range, with compensation influenced by factors such as experience, specialized skills, licensure, certifications, and organizational needs. Our base salary is part of a comprehensive Total Rewards package that includes an Annual Incentive Bonus based on corporate and individual performance, a 401(k) with employer matching, Paid Time Off (PTO), and attractive health benefits. The Annual Incentive Bonus is contingent on achieving corporate goals and individual performance metrics. Salary range: $118,691.00 - $189,906.00 Skills Actuarial Analysis Actuarial Modeling Actuarial Science Actuarial Services Benefits Analysis Budgeting Complex Project Management Financial Analysis Healthcare Management Office Administration People Management Pharmacy Provider Services Requirements Management Support Services Underwriting Management Note: Be cautious of job alert scams. We do not request personal financial information as part of the hiring process, and our career opportunities are exclusively posted on our established job site. Report any suspected fraudulent activity accordingly.

Created: 2026-03-05