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 healthcare. 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. The Impact You Will Have We are looking for an Actuary for our Medicare Provider Relations team! You will apply 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 team, independent actuarial analysis, actuarial judgement, and problem resolution will be critical to the performance of the Medicare Provider Network. You will collaborate with and presents results of analysis and recommendations to management and other departments, including Medicare segment leadership. This is a great opportunity to provide divisional representation and lead role corporate projects! Your Responsibilities 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 Required Skills and Experiences 5+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered. ASA or above. Strong oral and written communication skills. Excellent PC skills. Knowledge of data retrieval languages. Knowledge of BCBSMs databases or industry knowledge. High school diploma (or equivalency) and legal authorization to work in the U.S. Preferred Skills and Experience Bachelor's 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 Compensation and Benefits: Pay Range: $100,000.00 - $135,000.00 - $170,000.00 Annual Payis 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. Role Designation Hybrid Anchored in Connection Our hybrid approach is designed to balance flexibility with meaningful in-person connection and collaboration. We come together in the office two days a week-one designated anchor day with your team, and one day of your choosing. These in-person moments foster relationships, creativity, and alignment. The rest of the week you are empowered to work remote. Equal Employment Opportunity Statement At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. Blue Cross of Minnesota is an Equal Opportunity Employer and maintains an Affirmative Action plan, as required by Minnesota law applicable to state contractors. All qualified applications will receive consideration for employment without regard to, and will not be discriminated against based on any legally protected characteristic. Individuals with a disability who need a reasonable accommodation in order to apply, please contact us at: talent.acquisition@bluecrossmn.com. Blue Cross and Blue Shield of Minnesota and Blue Plus are nonprofit independent licensees of the Blue Cross and Blue Shield Association. Blue Cross and Blue Shield of Minnesota 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, or any other legally protected characteristic.
