Job Closed

This listing is no longer active.

E-Verify Program logo
E-Verify Program

Learn More About E-Verify and myE-Verify

Consulting Actuary – ACA Risk Adjustment

ActuaryActuaryOtherRemoteLeadTeam 501-1,000Since 1997H1B No SponsorCompany SiteLinkedIn

Location

Kentucky + 4 moreAll locations: Kentucky | Louisiana | North Carolina | Mississippi | South Carolina

Posted

134 days ago

Salary

$143.6K - $229.8K / year

Seniority

Lead

Bachelor Degree7 yrs expExperience acceptedEnglish

Job Description

Consulting Actuary – ACA Risk Adjustment

E-Verify Program

• 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

Job Requirements

  • 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.
  • 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 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

Related Categories

Related Job Pages

More Actuary Jobs

AAA - American Automobile Association logo

Actuarial Analyst, Commercial Pricing

AAA - American Automobile Association

A nonprofit founded in 1902 in Chicago, Illinois, the American Automobile Association (AAA) is recognized as North America’s largest provider of travel and mo

Actuary134 days ago

• Prepare and coordinate analyses for insurance rating • Support individual account pricing, perform portfolio ratemaking analyses, and lead projects of moderate complexity • Conduct actuarially sound statistical analysis by selecting appropriate data sources and making assumptions to develop recommendations for pricing • Document assumptions, methods, sources and considerations in an organized fashion • Prepare actuarial findings and documents that are suitable for technical and non-technical audiences • Participate in peer reviews to increase collaboration, ensure quality work and drive innovation • Collaborate with cross-functional teams, including product management, finance, and claims, to provide actuarial support • Follow industry developments, trends, market landscape, and emerging actuarial methods and tools • Depending on experience, provides mentorship and guidance for more junior colleagues • Provide analytical support to other functions on an ad hoc basis

Alabama + 23 moreAll locations: Alabama | Arizona | California | Colorado | Connecticut | District of Columbia | Florida | Idaho | Illinois | Iowa | Kansas | Kentucky | Louisiana | Maine | Montana | Maryland | Massachusetts | Michigan | Minnesota | Mississippi | Missouri | South Carolina | Virginia | Washington
$122.9K - $164K / year
Job Closed
EMC Insurance Companies logo

Senior Actuarial Analyst – Predictive Modeling

EMC Insurance Companies

EMC Insurance Companies, also known as Employers Mutual Casualty Company and EMC Insurance Group, is one of the United States' top 60 property/casualty insuranc

Actuary135 days ago

• Performs moderately complex actuarial work for ratemaking, reserving and/or modeling • Completes and coordinates the completion of pricing, reserving, and/or modeling work assignments including data preparation and analysis, and presents recommendations to key stakeholders • Applies industry standard methodologies and techniques for pricing, reserving, and/or modeling • Demonstrates methodologies and assumptions for other team members as appropriate • Tests, measures, and documents impacts of changes to methods, assumptions, and model variables • Researches market trends and emerging issues for potential impacts to EMC and opportunities for implementation • Ensures actuarial work conforms to professional standards • Recognizes, acknowledges, and documents assumptions, biases, and limitations • Detects and corrects errors in own and others’ work as identified in part of a peer review process • Utilizes Microsoft office products such as Excel, Word, PowerPoint, Power BI, as well as programming languages such as SQL to perform moderately complex pricing, reserving, and/or modeling analysis • Develops and maintains dynamic and macro driven Excel templates and data solutions for each line of business, state, and program • Addresses unique operational issues requiring special attention such as challenges posed by state regulatory requirements and/or changing economic environment

Iowa
$72.7K - $99.8K / year
Job Closed
OtherRemoteTeam 10,001+Since 1961H1B Sponsor

• responsible for setting pricing assumptions, submitting bids, filing and gaining approval of premium rates and rate certifications with regulatory agencies • Supports implementation of rates, new plans and benefit changes • Provides guidance to Product Development on new product/benefit cost impacts • Develops and maintains pricing tools that price standard and custom benefits • analyzes market level results and projections and develops recommended pricing actions to address gaps to targeted metrics • collaborates with sales and other partners supporting the markets to develop strategies for profitable membership growth • Accountable for actuarial certifications on rate filings, including attesting to compliance with state and federal rating and benefit regulations

United States
$80.9K - $110.3K / year
Job Closed
OtherRemoteTeam 10,001+Since 1961H1B Sponsor

• setting pricing assumptions, submitting bids, filing and gaining approval of premium rates and rate certifications with regulatory agencies • supports implementation of rates, new plans and benefit changes • provides guidance to Product Development on new product/benefit cost impacts • develops and maintains pricing tools that price standard and custom benefits • establishes market level financial metrics to align with segment profitability goals • analyzes market level results and projections and develops recommended pricing actions to address gaps to targeted metrics • leverages market level projections and experience data tools to research root cause and capture insights • researches and understands competitors in marketplace and collaborates with sales and other partners supporting the markets to develop strategies for profitable membership growth • accountable for actuarial certifications on rate filings, including attesting to compliance with state and federal rating and benefit regulations • begins to influence department’s strategy • makes decisions on moderately complex to complex issues regarding technical approach for project components

United States
$106.9K - $147K / year
Job Closed