Job Description

Position Description:
Base pay is influenced by several factors including a candidate's qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market driven rates. The salary range displayed has not been adjusted for geographical location. This range has been created in good faith based on information known to Capital Blue Cross at the time of posting and may be modified in the future. Capital Blue Cross offers a comprehensive benefits packaging including Medical, Dental & Vision coverage, a Retirement Plan, generous time off including Paid Time Off, Holidays, and Volunteer time off, an Incentive Plan, Tuition Reimbursement, and more.


At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it's why our employees consistently vote us one of the "Best Places to Work in PA."


Under general direction, performs financial projections and actuarial analysis for multiple projects or complex assignments. Recommends policies to safeguard the organization's financial integrity. May provide oversight and guidance to lower-level actuarial staff. Pursuit of actuarial exams is not required.


Responsibilities and Qualifications:

Pricing, Risk Adjustment & Cost of Care Analytics

Serve in a pre-management capacity for rate filings and pricing exercises. Analyze risk adjustment revenue impacts for both Medicare Advantage and Commercial business Perform cost of care analytics to evaluate medical trends, utilization patterns, and unit costs. Complete pricing exercises independently, draw conclusions, and provide actionable recommendations. Take ownership of deliverables, ensuring accuracy and clarity of results for both junior staff and management.

Forecasting & Healthcare Economics

Lead the development and completion of company forecasts, integrating healthcare economic factors such as cost trends, reimbursement structures, and utilization drivers. Analyze outcomes, identify improvements, and communicate findings to staff and leadership. Recommend adjustments based on economic, regulatory, and market shifts.

Revenue Analytics & Reserving

Take ownership of the monthly reserve process, including setting reserve cells and generating reports. Conduct revenue analytics to evaluate financial performance, revenue cycle drivers, and premium adequacy. Verify results, diagnose issues, and propose solutions. Present findings and conclusions clearly to both junior staff and management.

Data Analytics

Lead analysis of data prepared by junior staff across pricing, forecasting, reserving, and revenue functions. Validate accuracy, identify key issues, and provide actionable insights. Translate findings into business impacts and recommendations for leadership.

Management Reporting

Own the timely preparation of management reports, including cost, revenue, and utilization metrics. Ensure accuracy, make necessary updates, and resolve issues as they arise. Provide meaningful explanations of results to both staff and senior leaders.

Customer Service

Act as a primary actuarial contact for internal and external stakeholders. Communicate actuarial, cost of care, and financial findings in clear business terms. Build relationships with internal partners and serve as a representative voice for the actuarial function.

Mentoring & Development

Mentor junior actuarial staff and interns, teaching core principles and problem-solving techniques.

Skills

Strong analytical and problem-solving skills. Advanced mathematical and statistical abilities. Detail-oriented with high accuracy. Ability to manage moderately complex issues with technical expertise. Effective communication skills for technical and non-technical audiences.

Knowledge

Actuarial methods across pricing, forecasting, and reserving. Statistical modeling and analysis. Data management and technical tools. Healthcare economics and financial performance analysis.

Experience

10+ years of actuarial experience. Demonstrated expertise in cost of care analytics

,

revenue analytics

,

and healthcare economics. Experience validating financial models, conducting reserve analysis, and developing forecasts. Proven ability to translate technical findings into business insights and recommendations.

Education

Bachelor's degree in Mathematics, Statistics, Computer Science, Actuarial Science, or related field

Location:

This position is classified hybrid, which requires onsite work on Tuesdays and Wednesdays.

Physical Demands:

While performing the duties of the job, the employee is frequently required to sit, use hands and fingers, talk, hear, and see. The employee must be able to work over 40 hours per week. The employee must occasionally lift and/or move up to 5 pounds.

About Us: We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a caring team of supportive colleagues and be encouraged to volunteer in your community. We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career. And by doing your best, you'll help us live our mission of improving the health and well-being of our members and the communities in which they live.