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Job Description

Join our team as Director, Actuarial Services – Medicare Pricing and lead our Medicare pricing function for all Blue Cross NC Medicare products. You will develop and ensure application of actuarial policies, processes and methodologies. Responsible for financial stewardship of Blue Cross NC products and demonstrates a broad knowledge base of the health insurance industry.

What You’ll Do

+ Lead a team of actuaries responsible for pricing, forecasting, and strategic support of Medicare Advantage, Medicare Supplement, and Part D (PDP) products.

+ Oversee the Medicare Advantage bid development and submission process, coordinating efforts across internal teams and external consultants.

+ Demonstrate executive presence and communicate effectively across all levels of the organization, including presenting recommendations to Finance and Executive Leadership.

+ Collaborate with product, pharmacy, finance, and actuarial teams to support bid strategy, pricing decisions, and profitability analysis.

+ Influence and shape Medicare Advantage bid strategy to align with financial goals and broader business objectives.

+ Provide financial leadership on CMS updates and regulatory changes impacting Medicare pricing and reimbursement.

+ Drive continuous improvement in pricing operations, including automation, process optimization, and bid execution.

+ Facilitate the development of long-term pricing strategies that support organizational goals and respond to evolving market dynamics.

+ Communicate clearly and consistently with actuarial peers, internal stakeholders, and senior leadership.

+ Manage a team of people leaders and individual contributors, fostering professional growth and developing subject matter expertise across the team.

+ Oversee recruitment, onboarding, and retention to maintain a strong Medicare pricing team.

+ Allocate resources effectively across projects to ensure timely delivery of pricing recommendations, regulatory filings, and internal forecasts.

+ Maintain continuing education requirements as defined by the appropriate actuarial governing body (e.g., Society of Actuaries).

What You Bring

+ Bachelor’s or Master’s degree in Actuarial Science, Mathematics, Statistics, or related field

+ Fellow of the Society of Actuaries (FSA)

+ Member of the American Academy of Actuaries (MAAA)

+ Must have at least 8 years of relevant actuarial experience, including at least 3 year of formal leadership experience. Related experience may be considered.

+ In lieu of FSA, may consider candidates with alternate credentials.

+ In lieu of degree, 12+ years of experience in related field.

Bonus Points

+ 5+ years of pricing experience in one or more of the following: MA-PD, PDP, EGWP, MedSupp 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

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._

$173,776.00 - $278,041.00

Skills

Actuarial Analysis, Actuarial Management, Actuarial Science, Actuarial Services, Budgeting, Business Valuations, Client Management, Data Interpretations, Finance, Finance Strategy, Financial Modeling, Health Insurance, Leadership, Medicare Advantage, Medicare Part D, Medicare Plans, People Management, Pricing Processes, Problem Solving, Risk Assessments, Strategic Planning

About Us

It's an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Health care is changing, and we're leading the way. We offer more than health insurance our customers can count on. We’re committed to better health and better health care − in our communities and beyond. Our employees bring energy and creativity to the workplace, and it shows in our innovative approach to improving the health and well-being of North Carolinians.

Blue Cross NC is a fully taxed, not-for-profit company headquartered in Durham, North Carolina. We serve more than 4.3 million members, and we employ more than 5,000 people across the country who are passionate about making health care better for all.

Help us lead the charge for better health care by joining our award-winning team. Discover tremendous opportunities with us to do challenging and rewarding work. Opportunities that can lead you to a fulfilling career, work that can help others lead healthier, happier lives.

Authorization to Work in the United States

We use E-verify to confirm authorization to work in the United States. To learn more about E-Verify, including your rights and responsibilities, please visit E-Verify Overview (https://www.e-verify.gov/employees/e-verify-overview) for English or Visión General de E-Verify (https://www.e-verify.gov/es/empleados/vision-general-de-e-verify) for Español.

Request Accommodations

Blue Cross NC provides reasonable accommodations to applicants with disabilities. If you need a reasonable accommodation for any part of the application or hiring process, please notify HR at [email protected] .

For most roles, you can choose where to work - fully remote in one of the states listed below, in the office, or a hybrid of the two:

Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming