Risk Adjustment Actuary

About Blue Cross And Blue Shield Of Minnesota

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing.

If you are ready to make a difference, join us.

Blue Cross and Blue Shield of Minnesota is hiring a Risk Adjustment Actuary in Eagan, MN. This role is part of the Risk Adjustment Analytics team, which supports enterprise-wide initiatives across Medicare, ACA Commercial, and Medicaid. This position serves as a key technical leadership role on the team, guiding actuarial assumption development and analysis that support enterprise decision-making.

The Risk Adjustment Analytics team partners across legal, compliance, provider, and actuarial functions to support a broad range of risk adjustment work, including forecasting, pricing, audit support, and strategic initiatives. In this role, you will review and strengthen work before final delivery, help shape forecast assumptions, and support audit defense and proposed changes. You will also translate complex actuarial concepts into clear, actionable insights for business partners and senior leaders.

The ideal candidate is a credentialed actuary with strong actuarial judgment, recent knowledge of CMS model changes, and a consultative mindset. You bring the ability to independently analyze complex data, develop defendable assumptions, and support forecasting, valuation, and strategic decision‑making related to risk adjustment.

You are also skilled at working cross‑functionally, understanding the business context behind each request, and translating technical findings into meaningful recommendations for non‑technical audiences.

• Research, analyze and interpret actuarial and statistical data and provide technical assistance to other departments. This includes identifying issues to be researched, determining affected areas, estimating the impact and leading the resolution.
• Develop mathematical models in connection with other departments to predict impact of proposed changes. May also be involved in the design of these models.
• Understand/interpret the financial impact of decisions made by retrieving and analyzing claim costs, revenue and/or other relevant data. Participate in the design and implementation of new products and system enhancements by providing data and recommendations to assist in evaluating the impact of the proposed benefit, system or process changes.
• Responsible for divisional representation on corporate projects and may have leadership roles on these teams. Independently manage, which may include directing other staff, the retrieval and analysis of data on multiple tasks or projects with little or no management involvement.
• Act as a resource for other members of the department/division on business issues and may be responsible for training and guidance of Actuarial support personnel or Analysts. Makes satisfactory progress according to the Actuarial Student Program guidelines.
• Other specific accountabilities as assigned by management.

• 5+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
• ASA or above.
• Strong oral and written communication skills.
• Excellent PC skills. Knowledge of data retrieval languages.
• Knowledge of BCBSMs databases or industry knowledge.
• High school diploma (or equivalency) and legal authorization to work in the U.S.

• Bachelor's degree.
• FSA preferred.
• 3+ years of risk adjustment (RA) actuarial experience preferred.
• Demonstrated knowledge of recent CMS risk adjustment model changes and implications.
• Experience independently analyzing complex data and leading multiple risk adjustment‑related projects with minimal oversight.
• Proven ability to develop and refine risk adjustment assumptions, including applying…