Consulting Actuary - ACA Risk Adjustment
Blue Cross and Blue Shield of North Carolina
Consulting Actuary - ACA Risk Adjustment
Alabama, United States · Hybrid · 1w ago
ACA Exchange
- Salary
- $144k - $230k
- Experience
- 7+ Years
Role Summary
Role type
Specialist in a large health insurer
Closer to a carrier specialist than a consulting client role—the scope is concentrated on ACA risk adjustment within one insurer, despite external stakeholder contact.
Director-level Health actuarial role focused on ACA Exchange risk adjustment and pricing. You’ll influence risk adjustment performance, pricing, product design, financial targets, and enterprise decisions while partnering with leaders, vendors, regulators, and providers. The role is Hybrid Flex, generally requiring at least two office days weekly, with arrangements tied to distance from Durham headquarters.
Requirements
Must have
- Bachelor's degree required
- Member of the American Academy of Actuaries
- FSA designation
- 7 years of relevant actuarial experience
- In lieu of FSA, ASA with at least 9 years of relevant actuarial experience
- No visa sponsorship available
Strongly preferred
- Deep experience with ACA Risk Adjustment including HHS-HCC model methodology, risk score forecasting, and financial impact analysis
- Proven expertise in ACA Risk Adjustment transfer forecasting and explanation of results to senior leadership
- 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
Skills & Domain
ToolsExcel
DomainACA Risk AdjustmentHHS-HCC model methodologyRisk score forecastingDiagnosis coding (ICD-10-CM)