Actuary - Medicare Advantage Value-Based Contracting
About Blue Cross and Blue Shield of Minnesota
At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming health care. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us.
How Is This Role Important to Our Work?
This position applies broad actuarial principles and modeling technical skills to develop solutions to variable situations in the areas of health insurance primarily for the Medicare line of business. As a key part of the Medicare Provider Relations teams, independent actuarial analysis, actuarial judgement, and problem resolution will be critical to the performance of the Medicare Provider Network. Collaborates with and presents results of analysis and recommendations to management and other departments, including Medicare segment leadership. Provides divisional representation and may lead role corporate projects.
A Day in the Life:
Accountable for modeling the structure and outcomes of various value-based contracting (VBC) arrangements and enablement strategies to support Medicare network reviews. Inform the Medicare VBC strategy by projecting Medicare network and provider performance and identifying revenue generating or cost saving opportunities.
Works closely with actuarial, finance, data & analytics, stars, risk adjustment, and other lever owners to gather necessary data for modeling. Ensure inputs and assumptions leverage BCBSM source of truth/official estimates and are as up to date and technically sound as possible.
Lead the modeling of Medicare financial impact and provider financials from provider enablement investments.
Support individual provider negotiations as appropriate by assessing population-specific considerations and financial impact and tradeoffs from counterproposals. Monitor and project provider and vendor performance relative to established contracts.
Collaborate with actuarial, finance, Medicare and risk adjustment to ensure all inputs and assumptions leverage BlueCross source of truth and to ensure all estimates are as up to date and technically sound as possible.
Independently research, gather, analyze and interpret medical data.
Manage end-to-end modeling and solution development life cycle from requirements gathering, identification of data sources, model development and evaluation, to data processes and model implementation.
Understand/interpret model results and make business practice recommendations to improve pricing, risk selection, and forecasting.
Stays up-to-date with industry trend, regulations and best practices related to Medicare value-based payment models.
Makes satisfactory progress according to the Actuarial Student Program guidelines, if still in pursuit of actuarial accreditations.
Other specific accountabilities as assigned by management.
Nice to Have:
Bachelors degree in math, statistics, actuarial science, economics or related
FSA (Fellow of the Society of Actuaries)
Data querying and modeling experience in cloud platforms
Reporting experience with Power BI
Experience in advanced programming languages including but not limited to SQL, R, or SAS
Required Skills and Experiences:
5+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
Experience in Health Insurance or Medicare and in use of medical data
Strong statistical analysis or actuarial work and network modeling.
ASA (Associate of the Society of Actuaries)
Strong oral and written communication skills
Excellent Microsoft Excel, Word, PowerPoint skills.
Compensation and Benefits:
Pay Range: $100,000.00 - $135,000.00 - $170,000.00 Annual
Pay is based on several factors which vary based on position, including skills, ability, and knowledge the selected individual is bringing to the specific job.
We offer a comprehensive benefits package which may include:
Medical, dental, and vision insurance
Life insurance
401k
Paid Time Off (PTO)
Volunteer Paid Time Off (VPTO)
And more
To discover more about what we have to offer, please review our benefits page.
Equal Employment Opportunity Statement
Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, gender expression, or any other legally protected characteristic.
Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to [email protected].
All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.
Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association.
Apply Now
At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming health care. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us.
How Is This Role Important to Our Work?
This position applies broad actuarial principles and modeling technical skills to develop solutions to variable situations in the areas of health insurance primarily for the Medicare line of business. As a key part of the Medicare Provider Relations teams, independent actuarial analysis, actuarial judgement, and problem resolution will be critical to the performance of the Medicare Provider Network. Collaborates with and presents results of analysis and recommendations to management and other departments, including Medicare segment leadership. Provides divisional representation and may lead role corporate projects.
A Day in the Life:
Accountable for modeling the structure and outcomes of various value-based contracting (VBC) arrangements and enablement strategies to support Medicare network reviews. Inform the Medicare VBC strategy by projecting Medicare network and provider performance and identifying revenue generating or cost saving opportunities.
Works closely with actuarial, finance, data & analytics, stars, risk adjustment, and other lever owners to gather necessary data for modeling. Ensure inputs and assumptions leverage BCBSM source of truth/official estimates and are as up to date and technically sound as possible.
Lead the modeling of Medicare financial impact and provider financials from provider enablement investments.
Support individual provider negotiations as appropriate by assessing population-specific considerations and financial impact and tradeoffs from counterproposals. Monitor and project provider and vendor performance relative to established contracts.
Collaborate with actuarial, finance, Medicare and risk adjustment to ensure all inputs and assumptions leverage BlueCross source of truth and to ensure all estimates are as up to date and technically sound as possible.
Independently research, gather, analyze and interpret medical data.
Manage end-to-end modeling and solution development life cycle from requirements gathering, identification of data sources, model development and evaluation, to data processes and model implementation.
Understand/interpret model results and make business practice recommendations to improve pricing, risk selection, and forecasting.
Stays up-to-date with industry trend, regulations and best practices related to Medicare value-based payment models.
Makes satisfactory progress according to the Actuarial Student Program guidelines, if still in pursuit of actuarial accreditations.
Other specific accountabilities as assigned by management.
Nice to Have:
Bachelors degree in math, statistics, actuarial science, economics or related
FSA (Fellow of the Society of Actuaries)
Data querying and modeling experience in cloud platforms
Reporting experience with Power BI
Experience in advanced programming languages including but not limited to SQL, R, or SAS
Required Skills and Experiences:
5+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
Experience in Health Insurance or Medicare and in use of medical data
Strong statistical analysis or actuarial work and network modeling.
ASA (Associate of the Society of Actuaries)
Strong oral and written communication skills
Excellent Microsoft Excel, Word, PowerPoint skills.
Compensation and Benefits:
Pay Range: $100,000.00 - $135,000.00 - $170,000.00 Annual
Pay is based on several factors which vary based on position, including skills, ability, and knowledge the selected individual is bringing to the specific job.
We offer a comprehensive benefits package which may include:
Medical, dental, and vision insurance
Life insurance
401k
Paid Time Off (PTO)
Volunteer Paid Time Off (VPTO)
And more
To discover more about what we have to offer, please review our benefits page.
Equal Employment Opportunity Statement
Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, gender expression, or any other legally protected characteristic.
Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to [email protected].
All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.
Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association.
Apply Now