Blue Cross and Blue Shield Association logo

Assistant Actuary I - (Medicare Part D)

Blue Cross and Blue Shield Association
  • Philadelphia, PA
    30+ days ago

    Job Description

    Bring your drive for excellence, teamwork, and customer commitment to Independence. Join us as we renew and reimagine the future of health care. Together, we will achieve our mission to enhance the health and well-being of the people and communities we serve.

    We are seeking a senior actuary with deep experience in Medicare Part D pricing to join our Government Markets team. This role will have responsibility for the design, development, and ongoing ownership of Part D pricing models, including member-level projections used for forecasting and strategic decision making. Ideal candidates will have hands-on experience with Medicare Part D bid development or prior pharmacy experience.

    Key Responsibilities:

    • Own end-to-end design, development, and maintenance of Part D pricing models to project member-level drug utilization, cost sharing, plan liability, and CMS payments.
    • Translate complex Part D benefit designs, formularies, and CMS rules into robust model logic.
    • Lead reconciliation of seriatim model results to aggregate bid components, financial forecasts, and statutory reporting.
    • Establish modeling standards, validation frameworks, and documentation practices to ensure accuracy and transparency.
    • Provide expert judgment on key pricing assumptions, trends, and emerging risks impacting Part D financial performance.
    • Lead scenario analysis and strategic modeling (e.g., benefit redesigns, formulary changes, trend, risk mix, regulatory changes, customer level pricing) using seriatim projections.
    • Partner closely with finance, pharmacy, underwriting, product, and strategy teams to inform pricing decisions and corporate forecasts.
    • Monitor regulatory developments and CMS guidance, assess financial implications, and recommend pricing or strategy responses.
    • Present complex modeling results and recommendations to actuarial leadership and senior management.
    • Bachelor's degree in Actuarial Science, Mathematics, Statistics, or a related field.
    • 6+ years of actuarial experience, with significant focus on Medicare Part D pricing or pharmacy analytics.
    • Associate of the Society of Actuaries (ASA) designation.
    • Demonstrated experience building, owning, and validating complex actuarial models
    • Strong experience working with detailed healthcare claims data.
    • Proficiency in Excel and SQL; experience with R, SAS, or similar tools strongly preferred.
    • Strong communication skills, with the ability to translate technical results into clear business insights

    Preferred Experience:

    • Direct ownership of Part D bid pricing models or major bid components.
    • Experience leading or reviewing seriatim or claim-level actuarial models.
    • Demonstrated ability to exercise actuarial judgment in ambiguous or evolving regulatory environments.
    • Experience influencing pricing or strategy decisions through data-driven analysis.
    • Proven ability to manage multiple high-impact priorities in a deadline-driven environment.

    Independence has implemented a "Hybrid" model which consists of Associates working in the office 3 days a week (Tuesday, Wednesday & Thursday) and remotely 2 days a week (Monday & Friday). This role is designated as a role that fits into the "Hybrid" model. While associates may work remotely on our designated remote days, the work must be performed in the Tri-State Area of Delaware, New Jersey, or Pennsylvania.

    IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.

    Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.

    Numbers & Facts

    LocationPhiladelphia, PA
    IndustryInsurance
    Company Size2,000 to 2,499 employees
    Websitehttps://www.bcbs.com/about-us/careers

    About Company

    At the Blue Cross and Blue Shield Association (BCBSA), we provide business strategy, technical support and consulting expertise to 36 Blue Cross and Blue Shield companies across the nation, employing more than 1,000 of the best strategic thinkers in the industry. We are a Brand manager that sets quality control standards for the 36 independent companies that use the Blue Cross and Blue Shield Brands, and we serve as a trade association that represents these Blue companies. It is through our involvement that the Blues companies share a united vision and strategy while also benefiting from the local strength of all member companies.

    Skills

    • Actuarial Skillsunmatched
    • Analysis Skillsunmatched
    • Cisco ASA (Adaptive Security Appliance)unmatched
    • Communication Skillsunmatched
    • Content Management Systems (CMS)unmatched
    • Data Analysisunmatched
    • Financeunmatched
    • Financial Analysisunmatched
    • Forecastingunmatched
    • Formularyunmatched
    • Governmentunmatched
    • Healthcareunmatched
    • Leadershipunmatched
    • Mathematicsunmatched
    • Medicareunmatched
    • Model Validationunmatched
    • Monitor Regulationsunmatched
    • Pharmacyunmatched
    • Pricingunmatched
    • Product Pricingunmatched
    • Product Strategyunmatched
    • R Programming Languageunmatched
    • Reconciliationunmatched
    • Regulationsunmatched
    • Regulatory Reportsunmatched
    • Riskunmatched
    • SQL (Structured Query Language)unmatched
    • Statisticsunmatched
    • Team Playerunmatched
    • Time Managementunmatched
    • Underwritingunmatched
    • Validation Documentationunmatched

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