Medicare Actuary

Summary: 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.

What you will do: 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.

What you'll need: Required Bachelor's Degree or equivalent work 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. 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.

Required: Associate of the Society of Actuaries (ASA) - SOA

Required: Financial Services\Membership in the American Academy of Actuaries (MAAA)