Consulting Actuary - ACA Risk Adjustment

Consulting Actuary – ACA Risk Adjustment

As a Consulting Actuary – ACA Risk Adjustment, you will play a pivotal role in delivering a wide array of actuarial and analytical services for our organization. Your responsibilities will include leading pricing strategies, evaluating advanced care management models, conducting competitive benchmarking analyses, and designing and pricing sophisticated insurance products. You will support company objectives by providing reliable, actionable actuarial insights and recommendations, proactively identifying and addressing complex risks and opportunities.

• Accountable for completion of complex actuarial or analytical projects, ensuring timeliness, compliance, and quality of work.
• Provide proactive and strategic thought leadership to improve processes, reduce risks, and meet department and enterprise objectives for profitable growth and improved value, quality, and access for Blue Cross NC customers.
• Achieve segment financial targets and provide concise explanations of results and variances; 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 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 the job function, maintain actuarial credentials, and engage in thought leadership.

• 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, candidates with at least 9 years of experience and an Associate of the Society of Actuaries (ASA) will be considered.
• 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.
• Strong business acumen and communication 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

• Opportunity to work at the cutting edge of health‑care delivery with a team that is deeply invested in the community.
• Work‑life balance, flexibility, and the autonomy to do great work.
• 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.
• 401(k) match, including an annual company contribution.
• Competitive health benefits and wellness programs.
• Annual incentive bonus (subject to corporate goal achievement and individual performance).

We offer a base salary that reflects experience, training, licensure, and business needs. Typical base salaries range from $ to $. The total rewards package also includes an annual incentive bonus, 401(k) with employer match, paid time off, and competitive health benefits. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications, and other business and organizational needs.