Lead Actuary Medicare Advantage

Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health.  For over 90 years, we have been New Jersey’s health solutions leader driving innovations that improve health care quality, affordability, and member experience.  Our members are our neighbors, our friends, and our families.  It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds. 

About the Role

This role will support the actuarial bid pricing process for Horizon’s joint venture Medicare lines of business, in addition to providing detailed forecasts, conducting and tracking profitability analyses, and authoritatively communicating results and providing reporting to stakeholders and senior leadership.

What You'll Do

• Support actuarial pricing for the Medicare Advantage bid process and forecasting, working in conjunction with department leadership.

• Support developing a robust suite of internal tools for the bid process, member-level and cohort-level profitability analysis, and detailed forecasting.

• Forecasting and profitability analysis.

• Perform other ad-hoc analyses as requested (examples include assessing the impact of Star rating changes, benefit changes, or other changes).

• Investigate and communicate variances and drivers of forecasts to department leaders.

• Provide strategic thinking regarding the overall business strategy, incorporating product knowledge and broad Medicare Advantage landscape market dynamics. 

• Supervise and train junior actuaries as needed.

What You Bring

Education/Experience:

• Bachelors degree, required preferably within Mathematics, Statistics, Actuarial Sciences or a related field from an accredited college or university.

• Requires 5+ years of experience in Medicare Advantage actuarial bid pricing.

Additional licensing, certifications, registrations:

• Associate of the Society of Actuaries (ASA) or Fellow of the Society of Actuaries (FSA) preferred.

Knowledge

• Requires expert knowledge of Excel.

• Requires advanced proficiency with SAS or SQL.

• Requires expert knowledge of Medicare Advantage bid regulations and bid instructions.

• Requires in depth knowledge of the Medicare Advantage industry.

Skills and Abilities:

• Requires excellent oral and written communication skills.

• Requires strong analytical thinking.

• Requires strong mathematical skills and statistical analysis abilities.

• Requires good judgment and problem solving skills.

• Requires strong leadership skills.

Why Horizon?

At Horizon, you’ll do meaningful work that directly improves lives—while being supported by a mission‑driven organization that values expertise, collaboration, and growth.  We believe that when our people thrive, our communities do too.  If you are passionate about making an impact, we’d love to hear from you!

Salary Range:

$113,200 - $154,455

​This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity.  This range has been created in good faith based on information known to Horizon at the time of posting.  Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:

• Comprehensive health benefits (Medical/Dental/Vision)

• Retirement Plans

• Generous PTO

• Incentive Plans

• Wellness Programs

• Paid Volunteer Time Off

• Tuition Reimbursement

Disclaimer:

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware. This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.

Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law.  Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.