Senior Consulting Actuary - Risk Adjustment Expert

Job Description Are you a seasoned actuary passionate about influencing risk adjustment strategies? Join our team as a Senior Consulting Actuary specializing in ACA Risk Adjustment. In this pivotal role, you will significantly shape our actuarial and analytical services to drive pricing strategies, evaluate care management models, and design innovative insurance products. Your contributions will be essential in addressing complex risks and identifying opportunities for our company to achieve its objectives. What You'll Do Lead intricate actuarial projects from start to finish, ensuring compliance, quality, and timely delivery. Identify and implement opportunities for process enhancements, risk mitigation, and increased value, focusing on profitable growth for our customers. Meet and surpass financial targets while clearly explaining results and variances, serving as an effective financial steward. Communicate adeptly with organizational leadership and various stakeholders. Manage external relationships with vendors, auditors, regulators, and healthcare providers, negotiating contracts and rates effectively. Build and maintain strong internal business relationships, offering exceptional support as a strategic advisor. Commit to continuous professional growth and maintain actuarial credentials through ongoing education. What You Bring A Bachelor's degree or higher as required. Active membership in the American Academy of Actuaries. Fellowship of the Society of Actuaries is highly preferred. At least 7 years of relevant actuarial experience, with candidates holding 9 years and an ASA credential also encouraged to apply. Bonus Points Extensive experience with ACA Risk Adjustment, specifically in HHS-HCC model methodology, risk score forecasting, and financial impact analysis - Highly Preferred. Proven track record in ACA Risk Adjustment transfer forecasting and presenting results to senior leadership - Highly Preferred. Strong grasp of ICD-10-CM diagnosis coding, provider documentation, and their importance on risk adjustment outcomes. Advanced analytical skills to pinpoint risk adjustment leakage, emerging risks, and optimization opportunities among ACA populations. What You'll Get A chance to work at the forefront of healthcare delivery within a community-focused team. Work-life balance, flexibility, and the autonomy to excel in your role. Comprehensive medical, dental, and vision benefits along with various health and wellness programs. Supportive parental leave policies and assistance with adoption and surrogacy. Access to career development initiatives and tuition reimbursement for continuing education. 401k match with annual company contributions. Salary Range At Blue Cross NC, we prioritize competitive and equitable compensation packages that align with market standards. Our salaries are typically set near the midpoint of the specified range. Decisions on compensation take into account factors such as experience, specialized skills, and relevant certifications. The base salary is complemented by a comprehensive Total Rewards package, which includes an Annual Incentive Bonus based on both corporate goals and individual performance. Eligibility for Annual corporate goal achievement and individual performance bonus. $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: 2026-03-10