Actuary

• Use expertise in mathematics, statistics, health insurance, and business to support complex pricing, valuation, and financial forecasting.
• Lead analyses that shape pricing models, care management programs, and insurance product development.
• Turn complex data into clear, actionable recommendations that guide strategic decisions.
• Identify emerging risks and opportunities in a rapidly evolving industry.

Principal Actuary – ACA Pricing

• 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.
• Develop measurement models for various cost savings initiatives across the company’s many strategic areas including, but not limited to clinical care management, alternative payment arrangements with providers, medical coding and policy adherence practices, and other emerging drivers of trend.

Principal Actuary, Cost of Care

• Demonstrate commitment to career development and growing financial acumen by pursuing actuarial credentials and membership in the Society of Actuaries
• Prepare and analyze intermediate level data for use in actuarial experience studies, valuation or pricing projects
• Assist in maintenance of pricing and underwriting tools and provide support for helping others understand underwriting case specific issues by answering technical questions
• Develop reserve factors
• Develop experience analysis reviews
• Assist in maintaining valuation system
• Assist in preparation of financial reports, tax returns and state filings as needed
• Learn current pricing models and risk management practices
• Contribute to product development and re-pricing initiatives
• Communicate research results to manager both in written format and orally
• Prepare routine reports
• Continuous assessment of established training and work processes to identify areas for effectiveness and efficiency improvements.
• Contribute to operating effectiveness through information sharing, suggested process improvements and effective implementation of change
• Communicate trends and issues identified and proactively recommend resolutions to management
• Work on special projects that require actuarial research and analysis which may involve partnering with other business areas both in and out of finance.
• Continuously build a specialized working knowledge of the company operations, systems and in the actuarial discipline
• May perform other duties as assigned

Actuarial Assistant, Actuarial Development Program

• Develops reporting structure, toolset and analytic strategy to support market and domain teams as well as pricing for programs and products.
• Supports the rating process by determining the need for and building actuarial model enhancements.
• Distributes established reports and responds to inquiries.
• Supports the investigation of trends and anomalies.
• Coordinate and independently develop BI content (reports, dashboards, scorecards, more complex analytic solutions) through the entire development life-cycle to provide data necessary to effectively make business decisions and measure goal attainment and overall performance.
• Share expertise with business areas to assist in understanding enterprise data content, definitions and usage and the available BI tools.
• Maintains robust knowledge of data assets and tools and supports development/maintenance of a formal Knowledge Base.
• Plans, implements, manages and/or contributes to projects that are moderate/high complexity.

Senior Actuarial Analyst – Medical Economics

• Serve as a senior-level individual contributor within the Pharmacy Analytics team
• Support the organization’s pharmacy strategy through advanced actuarial and analytical expertise
• Perform complex actuarial analyses, generating actionable insights
• Inform strategic decision-making to drive business outcomes
• Collaborate closely with cross-functional stakeholders and other actuarial teams
• Provide guidance and oversight to junior team members

Consulting Actuary – Pharmacy

• Performs actuarial research, experience studies, and statistical analyses and calculations.
• Calculates premiums and reserves of new and existing plans of insurance.
• Provides support to senior analysts or actuaries as required.
• Retrieves and validates data for rate filings and actuarial models.
• Builds model enhancements and determines reasons for changes to calculated factors.
• Analyzes impacts of changes to product lines and segments.
• Communicates filing status to internal stakeholders and transmits rate filings to regulatory agencies (NCDOI, CMS).
• Retrieves and validates data for monthly reports and for UCL and ALR calculation.
• Supports valuation by executing ALR model and verifying results.
• Researches to support ALR assumption studies and UCL estimates.
• Distributes established reports and responds to inquiries.
• Investigates trends and anomalies.
• Executes control activities to support Enterprise Risk Management.
• Provides analytic support for corporate and departmental projects.
• Is a participant in good standing in the Actuarial Development Program

Actuarial Analyst

• Lead and maintain a high-performing team, with an emphasis on technical and professional development.
• Lead staff through completion of technical projects, ensuring timeliness, compliance, and quality of work.
• Assist in development and leads staff in creation, maintenance, and/or improvement of key processes, models, and reports, including process control documents.
• Provides 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 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 peers across the enterprise, including Actuarial and Divisional Leadership Teams.
• Support external partnerships with vendors, auditors, regulators, and/or health care providers.
• 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.

Senior Manager, Actuarial Services – Large Group

• Performs qualitative and quantitative analysis of data to support development of rating plans and pricing for programs and products.
• Evaluates moderately complex trend analysis.
• Supports the rating process by determining the need for and building actuarial model enhancements.
• Determines reasons for changes in calculated factors and communicates changes to internal stakeholders.
• Reviews and observe appropriateness of actuarial formulae.
• Transmits rate filings to regulatory agencies (NCDOI, CMS).
• Supports valuation by modifying and executing the ALR model.
• Distributes established reports and responds to inquiries.
• Investigates trends and anomalies.
• Supports resolution of control exceptions and maintains control documentation.
• Participates in requirements gathering for and serves as delegate or backup for corporate projects.

Senior Actuarial Analyst

• Synthesize cost, utilization, mix, and unit cost dynamics to identify emerging risks and opportunities impacting market and segment financial performance
• Translate complex medical cost dynamics into implications and recommendations that directly inform market strategy, pricing, and financial planning
• Proactively identify, size, and frame cost management opportunities using rigorous, transparent analytics
• Integrate insights across medical economics domains into a cohesive, market-specific narrative
• Responsible for maintaining continuing education requirements as set by the appropriate Actuarial governing body (i.e. Society of Actuaries)

Principal Actuary – Medicare Advantage

• Define and execute the enterprise pricing strategy, aligning with business objectives for growth, profitability, and risk selection
• Lead, develop, and scale a high-performing pricing team, building strong technical and leadership capabilities
• Act as a key advisor to senior leadership, translating pricing insights into actionable business decisions
• Oversee pricing across all products, with accountability for rate adequacy, segmentation, and overall portfolio performance
• Apply advanced ratemaking and modeling techniques to enhance pricing sophistication and market competitiveness
• Partner closely with underwriting and product teams to optimize portfolio mix and support profitable growth
• Lead the modernization of the pricing function, including tools, data infrastructure, and operating model
• Drive adoption of advanced analytics and machine learning to improve pricing accuracy and responsiveness
• Establish scalable, efficient pricing processes and foster a culture of innovation and continuous improvement

VP, Head of Actuarial Pricing

• Work in a fast-paced, innovative, and change-oriented work environment
• Build a strong network of peers and mentors
• Attend on-site technical and professional development classes
• Participate in sponsored community service events
• Utilize advanced Excel techniques and programming
• Work with large data sets
• Gain exposure to actuarial software, including GGY AXIS, MG-ALFA, and PolySystems

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