Consulting Actuary – ACA Risk Adjustment
E-Verify Program
full-time
Posted on:
Location Type: Hybrid
Location: Kentucky • Louisiana • United States
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Salary
💰 $143,616 - $229,786 per year
About the role
- 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
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
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
actuarial analysisrisk score forecastingfinancial impact analysisdiagnosis codingICD-10-CMrisk adjustment forecastinganalytical skillsprocess improvementcompliance managementcontract negotiation
Soft Skills
strategic thought leadershipeffective communicationrelationship managementnegotiationbusiness expertiseproblem-solvingteam collaborationleadershipadvisory skillsorganizational skills
Certifications
Bachelor's degreeadvanced degreeMember of the American Academy of ActuariesFellow of the Society of ActuariesAssociate of the Society of Actuaries