Senior Actuary - ACA Risk Adjustment Leadership

Job Description We invite you to be a part of our dynamic team as a Senior Actuary with a focus on ACA Risk Adjustment. In this pivotal role, you will contribute to a wide range of actuarial and analytical services that drive our organization towards success. Your expertise will be crucial in shaping pricing strategies, evaluating advanced care management models, conducting competitive analyses, and developing innovative insurance products. By delivering valuable insights and proactive risk management, you will ensure our actuarial practices remain ahead of industry trends and standards. What You'll Do Lead complex actuarial projects, ensuring timely execution, compliance with regulations, and adherence to our high-quality benchmarks. Drive strategic initiatives focused on process enhancement, risk reduction, and the achievement of departmental and organizational goals aimed at sustainable growth and improved customer value. Exceed financial targets while clearly communicating results and variances; act as a diligent steward of the company's financial resources. Communicate effectively across all levels of the organization, including top leadership. Manage relationships with external stakeholders, such as vendors, auditors, regulators, and healthcare providers, ensuring favorable contracts and agreements. Foster strong internal collaborations by providing your expertise and exceptional support, positioning yourself as a trusted strategic advisor. Stay informed on continuing education requirements to maintain your actuarial credentials and contribute to industry thought leadership. What You Bring A Bachelor’s or advanced degree as required. Membership in the American Academy of Actuaries. Fellowship in the Society of Actuaries is preferred; candidates with an Associate designation and at least 9 years of relevant actuarial experience will also be considered. A minimum of 7 years of related actuarial experience. Bonus Points Extensive experience in ACA Risk Adjustment, especially with HHS-HCC model methodologies, risk score forecasting, and financial impact assessment. Demonstrated expertise in ACA Risk Adjustment transfer forecasting and effectively communicating insights to senior leadership. Strong understanding of diagnosis coding (ICD-10-CM), provider documentation practices, and their implications on risk adjustment outcomes. Advanced analytical skills to identify opportunities in risk adjustment leakage, emerging risks, and optimization among ACA populations. What You'll Get The opportunity to work with a team dedicated to enhancing healthcare delivery and making a positive impact in the community. Flexibility, a balanced work-life experience, and the resources to thrive in your career. Comprehensive medical, dental, and vision coverage, along with various health and wellness programs. Support for parental leave and assistance with adoption or surrogacy. Access to ongoing career development programs and tuition reimbursement for further education. A competitive 401(k) plan with employer matching and contributions. Discover more about our offerings. Salary Range At Blue Cross NC, we pride ourselves on providing a competitive compensation package aligned with market standards. Our starting salaries are typically within the mid-range, with final decisions based on experience, specialized skills, licensing, and other organizational criteria. Our base salary is part of a comprehensive Total Rewards package, which includes an Annual Incentive Bonus, 401(k) matching, Paid Time Off (PTO), and comprehensive health benefits. Bonus potential is contingent upon annual performance and company goals. $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

Created: 2026-03-05