Jobs at Blue Cross And Blue Shield Of North Carolina

5 open positions · $66,998 - $229,786

Open roles

Manager - Medicare Formulary Strategy Actuarial Associate - Medicare Principal Actuary - Medicaid Actuarial Associate - Medicare Pricing Consulting Actuary - ACA Risk Adjustment

Manager - Medicare Formulary Strategy

NC, US

The Medicare Formulary Strategy Manager will lead the design, development, and execution of formulary strategies (Part D and Part B) for all Medicare formularies, including MAPD (HMO, PPO, DSNP), PDP and EGWP. This role requires close collaboration with cross-functional partners-including Medicare Pharmacy Operations, UM Operations, Compliance, STARS, Medical Management, Actuary, Product, Clinical, and Finance teams to ensure formularies are clinically appropriate, cost-effective, competitive in the marketplace, and compliant with CMS regulations. How you will make an impact: Formulary Development \& Strategy Leads the annual Medicare formulary planning process from kick-off through CMS submission and final approval. Develops and executes Medicare formulary strategies that balance clinical efficacy, cost-effectiveness, compliance, and competitive positioning. Conducts competitive analyses, assesses rebate and lowest net-cost opportunities, evaluates customer cohort profitability analyses, and product-specific strategies aligned with evolving product and market needs. Supports the development of custom formularies tailored to the needs of each Medicare product. Researches market trends, evaluates competitive positioning, and assesses the regulatory landscape to guide Medicare formulary strategies. Governance \& Review Participates in the Pharmacy \& Therapeutics (P\&T) and Business Assessment Committee, ensuring evidence-based decision-making and CMS compliance. Partners with Actuarial, Finance, Clinical and Product teams to model financial scenarios, assess member impact, and evaluate competitive positioning. Conducts ongoing and ad hoc reviews focused on specialty tiers, utilization management, STARS performance, and high-cost/high-trend drugs. Ensures P\&T compliance with CMS regulatory standards Works with PBM and internal partners to ensure CMS approval of formularies. Market Monitoring \& Trends Monitors emerging drug trends, competitive market dynamics, and utilization patterns to proactively identify opportunities or risks. Partners with Actuary and Data \& Analytics teams to conduct analyses of formulary performance, including customer cohort profitability, trend tracking, UM performance, and tier exception reviews. Refines strategy based on market intelligence and performance insights. What You Bring Bachelor's degree or advanced degree (where required) 8+ years of experience in related field. In lieu of degree, 10+ years of experience in related field. Current valid active unrestricted state(s) RPH license required. Bonus Points (preferred qualifications) A minimum of 5 years of Medicare managed care pharmacy experience; or any combination of education and experience, which would provide an equivalent background. Advance degree preferred (PharmD, MBA, MPH, or equivalent). Minimum of 5 years of experience in Medicare Part D \& B formulary management with a Medicare plan sponsor or pharmacy benefit manager (PBM). Strong understanding of Medicare Part D \& B formulary requirements and regulatory guidance. Strong understanding of Medicare regulatory requirements for Pharmacy and Therapeutics Committees Strong analytical, data interpretation, and trend management skills. Knowledge of Part D Stars measures and their application in formulary strategy. Excellent communication and presentation skills, with the ability to engage leadership and cross-functional stakeholders. Strategic planning and execution within the Medicare environment. Ability to synthesize clinical, financial, and regulatory insights into actionable strategies. Strong analytical and problem-solving abilities. Proven project management skills, including timeline development, prioritization, and cross-functional coordination. What You’ll Get The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community Work-life balance, flexibility, and the autonomy to do great work 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 #LI-DNI Salary Range At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus\, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs. Based on annual corporate goal achievement and individual performance.* $130,560.00 - $208,896.00 Skills

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Actuarial Associate - Medicare

NC, US$66,998 - $107,197/yr

We are seeking a motivated Associate Actuary to join our team. In this role, you will apply your mathematical and statistical knowledge to support activities such as rating, valuation, healthcare economics, and financial forecasting. Guided by experienced actuaries, you will contribute to health programs and offer actuarial support across departments, including Network Management, Underwriting, Sales and Marketing, Finance, and Healthcare. This is an excellent opportunity for individuals starting their actuarial career and looking to gain broad experience in the field. What You’ll Do Analyzes financial, statistical and mathematical data and performs actuarial calculations. May assist in the determination of pricing, reserves and/or cash flow projections. Assists in performing rate studies used in determining rate adequacy. Assists in actuarial research, experience studies, and statistical analyses and calculations. Provides support to senior analysts or actuaries as required. Retrieves and validates data for rate filings and actuarial models. Assists senior staff in the building of model enhancements and determines reasons for changes to calculated factors. Distributes established reports and responds to inquiries. Investigates trends and anomalies. Supports Enterprise Risk Management. Provides analytic support for corporate and departmental projects. Is a participant in good standing in the Actuarial Development Program What You Bring Bachelor's degree or advanced degree (where required) 0-2 years of experience in related field Completed 1-2 actuarial exams towards the eventual attainment of the ASA designation. Bonus Points Previous Medicare experience a plus Previous Actuarial Internship experience a plus SQL, SAS, Python experience What You’ll Get The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community. Work-life balance, flexibility, and the autonomy to do great work. 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 Learn more Salary Range At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus\, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs. Based on annual corporate goal achievement and individual performance. $66,998.00 - $107,197.00 Skills Medicare

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Principal Actuary - Medicaid

NC, US$118,691 - $189,906/yr

We’re seeking a strategic and technically experienced Principal Actuary to lead complex actuarial work that informs key business decisions across our organization. In this role, you will apply advanced expertise in mathematics, probability, statistics, and health insurance to guide sophisticated pricing, valuation, and financial forecasting initiatives. Blue Cross NC’s Medicaid lines of business are administered through a joint partnership with another health plan. The other health provides the actuarial services for Medicaid. This position will be the first Medicaid actuarial position on the Blue Cross NC side, and is intended to work closely with our partner plan to interpret reserving results and trends, and ensure Blue Cross NC leadership is able to understand run-rate analysis, apply appropriate accounting and financial reporting treatments, and understand drivers of financial variance and trends. This actuary will report into the Valuation/Reserving function. What You’ll Do Actively contributes to the success of the Actuarial Services team. Responsible for handling highly complex actuarial modeling. Leads and/or provides consultative support to assigned projects and is viewed as an expert in the field. Assists in Rating/Pricing Develop/Maintain rating models Perform Medical Trend analysis Support Administrative Expense factor development Conduct Experience Studies Conduct Rating Factor Studies Support Rate Filing development Assists in support for Financial Forecasting Works with FP\&A to support development of Plan forecast for assigned segments Assists in support for Network Management Support evaluation of financial impacts of provider contract changes Assists in support for Underwriting (all segments) Provide ad hoc support for underwriting requests Assists in support for Sales and Marketing Provide support for new product development Provide support for new/existing product programs Continuing Education Responsible for maintaining continuing education requirements as set by the appropriate Actuarial governing body (i.e. Society of Actuaries) Is a participant in good standing in the Actuarial Development Program, if still pursuing the FSA designation What You Bring Bachelor's degree or advanced degree (where required) Associate of the Society of Actuaries (ASA) and Member of the American Academy of Actuaries (MAAA) 5+ years of experience in related field In lieu of an ASA, alternate actuarial credentials may be considered. In lieu of 5 years of experience, may consider candidates who are Fellows of the Society of Actuaries (FSA). Bonus Points Prior experience with Medicaid Highly Preferred Prior experience in Health Reserving Highly Preferred Prior experience with Financial Reporting \& Accounting Highly Preferred What You’ll Get The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community. Work-life balance, flexibility, and the autonomy to do great work. 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 Learn more Salary Range At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus\, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs. Based on annual corporate goal achievement and individual performance.* $118,691.00 - $189,906.00 Skills Actuarial Pricing, Actuarial Science, Financial Data Reporting, Financial Reporting and Analysis, Medicaid, Underwriting

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Actuarial Associate - Medicare Pricing

NC, US$66,998 - $107,197/yr

As an Associate Actuary focused on Medicare Pricing, you will work under direct supervision to apply your background in mathematics, probability, and statistics to support the financial and actuarial needs of our organization. You will collaborate with a team of actuaries to assist in rating/pricing, valuation, healthcare economics, and financial forecasting for Blue Cross NC Medicare products. In this role, you will provide essential actuarial support to departments such as Network Management, Underwriting, Sales and Marketing, Finance, and Healthcare. Your work will contribute to pricing, forecasting, and strategic initiatives for our Medicare offerings. What You’ll Do Performs actuarial research, experience studies, and statistical analyses and calculations using Excel, SQL, and SAS. Calculates premiums, risk scores, and reserves of new and existing plans of insurance. Provides support to senior analysts or actuaries as required. Retrieves and validates data for 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). Distributes established reports and responds to inquiries. Investigates trends and anomalies. Provides analytic support for corporate and departmental projects. What You Bring Bachelor's degree or advanced degree (where required) 0-2 years of experience in related field Completed 1-2 actuarial exams towards the eventual attainment of the ASA designation. Bonus Points Previous Medicare experience a plus Previous Actuarial Internship experience a plus SQL/SAS experience a plus What You’ll Get The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community. Work-life balance, flexibility, and the autonomy to do great work. 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 Learn more Salary Range At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus\, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs. Based on annual corporate goal achievement and individual performance. $66,998.00 - $107,197.00 Skills Actuarial Science, Medicare

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Consulting Actuary - ACA Risk Adjustment

NC, US$143,616 - $229,786/yr

As a Consulting Actuary -ACA Risk Adjustment, you will play a pivotal role in delivering a wide array of actuarial and analytical services for our organization. Responsibilities include leading pricing strategies and actuarial initiatives for business segments, evaluating advanced care management models, conducting competitive benchmarking analyses, and designing and pricing sophisticated insurance products. You will support company objectives by providing reliable, actionable actuarial insights and recommendations, proactively identifying and addressing complex risks and opportunities. This position requires adaptability to the evolving landscape of the industry, ensuring our actuarial practices remain at the forefront of innovation and excellence. What You’ll Do 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 What You Bring 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. Bonus Points 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 What You’ll Get The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community. Work-life balance, flexibility, and the autonomy to do great work. 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 Learn more Salary Range At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus\, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs. Based on annual corporate goal achievement and individual performance.* $143,616.00 - $229,786.00 Skills Actuarial Analysis, Actuarial Management, Actuarial Science, Actuarial Services, Affordable Care Act (ACA), Complex Care Management, Financial Reporting and Analysis, Hiring Management, Insurance Industry, Organizational Leadership, Regulatory Compliance

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Blue Cross And Blue Shield Of North Carolina office locations

NC, US

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