Director, Actuarial Services - Medicare Pricing

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

Bonus Points

What You'll Get

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

$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