Consulting Actuary - ACA Risk Adjustment
Blue Cross NC
Consulting Actuary - ACA Risk Adjustment
North Carolina, United States · Flexible · Yesterday
- Salary
- $140k - $174kest.
- Experience
- 7+ Years
Role Summary
Role type
Specialist in a large health insurer
Closer to a specialist insurer role than a broad consulting assignment—the defining feature is deep ACA risk adjustment expertise within one health business.
Senior Health actuarial role supporting ACA Exchange and Individual Health risk adjustment in North Carolina. You’ll influence pricing, product design, risk adjustment forecasting, financial performance, and business decisions while partnering with leaders, providers, vendors, auditors, and regulators. The role offers Hybrid-Flex or Remote-Flex arrangements depending on location and work needs.
Requirements
Must have
- Eligible to work in the US without sponsorship
- Meet continuing education standards required for job function and actuarial credentials
Strongly preferred
- 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
- ASA with at least 9 years relevant actuarial experience accepted in lieu of FSA
- Deep ACA Risk Adjustment experience including HHS-HCC methodology, risk score forecasting, and financial impact analysis
- ACA Risk Adjustment transfer forecasting and explanation to senior leadership
Nice to have
- Understanding of ICD-10-CM diagnosis coding and provider documentation impact on risk adjustment
- Advanced analytical skills to identify risk adjustment leakage, emerging risks, and optimization opportunities
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