Teams 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.