Medicare Actuary

We are seeking an experienced Medicare Actuary to perform modeling and analysis for the Federal Employee Program Medicare Advantage and Part D Employer Group Waiver Program (MAPD/PDP EGWP). This role works independently primarily focusing on EGWP pricing, benefit design, CMS revenue, and risk adjustment, evaluating the financial implications of program and regulatory changes while supporting reserving, forecasting, and experience monitoring. The ideal candidate brings expertise in CMS payment models, RAF and HCC analytics, and Medicare Advantage/Part D bid development, serving as the subject matter expert on Medicare Advantage, Part D, and EGWP financial matters.
Develops, manages, and provides the evaluation, implementation, and maintenance of models and studies, which use actuarial principles for the purposes of pricing, underwriting, reserving, trend analyses, rating support, forecasting, and other actuarial functions as needed. Summarizes results, provides observations, and communicates recommendations to support management decisions.
Leads, develops, analyzes, and quantifies the effects of new initiatives, proposals, environmental changes such as: laws/regulation, tax policy; trend; competitor, member, and provider behavior impacting FEP, BCBSA, or Blue Plans, as appropriate. Analyzes the financial effect and determines the estimated actuarial impact as well as develops and implements appropriate solutions.
Responds to a variety of technical inquiries or requests and provides technical actuarial support to internal customers or external customers (OPM, CMS, Congress, etc.), and Blue Plans upon request. Leads and evaluates the Plan Trend Surveys and other BCBSA publications as requested.
Leading actuarial presentations at meetings, conferences, and training sessions as requested.
Maintains actuarial credentials which may include continued progression through the actuarial examination process.
The posting range for this position is:
127,500.00 - 184,875.00
Qualifications:
Education
Required Bachelor's Degree or equivalent work experience
Experience
Required 7+ Years actuarial experience, with multiple years in Medicare Advantage/Part D, medical, dental, and/or vision insurance, or other health related experience.
Knowledge Skills and Abilities
Substantial health actuarial and related technical expertise in rating, underwriting, valuation, product development, trend analysis, forecasting, rate filings, financial statements, legislative analysis, policy development, and R&D projects is required.
General understanding of data support systems and data requirements.
Ability to work effectively in multi-disciplinary team environment.
Excellent oral and written communication skills, as well as effective presentation skills in both formal and informal settings with the ability to present technical information to non-technical audiences
Demonstrated technical skills with the Microsoft Office Suite are required, including Microsoft Excel.
Skilled in basic accounting and financial analysis.
Experience in Access, SAS, SQL, Visual Basic, R, or other programming skills.
Ability to exercise independent actuarial judgement
Preferred: Demonstrates AI literacy and an understanding of generative AI tools, including appropriate business applications and limitations.
Certifications & Licenses
Required: Associate of the Society of Actuaries (ASA) - SOA
Required: Financial Services\Membership in the American Academy of Actuaries (MAAA)
#LI-Hybrid
The posted salary range is the lowest to highest salary we, in good faith, believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the hiring range and this hiring range may also be modified in the future. A candidate’s position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs. This job is also eligible for annual bonus incentive pay.
We offer a comprehensive package of benefits including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching, lifestyle spending account and many other benefits to eligible employees.
Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.