Jobs at Blue Cross NC

Support actuarial teams with rating, pricing, valuation, and forecasting for health programs. Perform data retrieval/validation, experience studies, statistical analyses, ALR/UCL calculations, rate filings, and reporting. Collaborate with underwriting, network, finance, and other stakeholders and participate in the Actuarial Development Program.

Provides legal counsel for pharmacy benefit management and State Health Plan operations. Responsibilities include interpreting PBM contracts, advising on state and federal health plan regulations, supporting vendor oversight, privacy and data governance, audits, public records requests, claims and appeals, regulatory inquiries, and implementation initiatives. The role also monitors legal developments, trains stakeholders, and helps manage contractual, compliance, and operational risks.

Leads development and maintenance of actuarial data marts, datasets, extracts, reports, and analytical solutions supporting claims analysis, IBNR reserving, forecasting, trend analysis, and financial reporting. Partners with actuarial, finance, medical economics, and data teams to validate and reconcile healthcare data, automate refreshes, ensure auditability, and improve data quality. Provides technical leadership, requirements expertise, recommendations, training, and direction to junior staff and business partners.

Lead complex actuarial projects focused on ACA risk adjustment, pricing, forecasting, and competitive benchmarking. Provide strategic actuarial guidance, manage vendor and regulator relationships, achieve financial targets, and communicate results to senior leadership while maintaining actuarial credentials.

Lead short-, medium-, and long-term cash flow forecasting; analyze liquidity trends, risks, and opportunities; communicate actionable insights to senior management and the Board; partner with Finance, Treasury, Actuarial, Investments, and business leaders; and optimize excess cash according to investment policies.

Provides audit and risk advisory services across subsidiaries, focusing on financial, strategic, and entity-level risks and controls. Performs walkthroughs, control testing, process analysis, audits, deficiency assessments, remediation validation, and advisory engagements. Uses COSO and related frameworks to strengthen governance and internal controls, develops mitigation strategies, documents findings, trains management, and prepares audit reports.

Lead design, development, and delivery of ML, DL, and Generative AI systems for production. Apply prescriptive analytics, optimization, recommendation, and reinforcement learning. Build and evaluate models, run experiments, develop prototypes, benchmark methods, and collaborate with business partners to translate data into actionable recommendations and influence strategy.