IT Support Specialist providing engineering department IT support at Boston Government Services in Oak Ridge, Tennessee. Collaborating closely with engineering leads and external stakeholders to address IT needs.
About the role
- Principal Actuary providing oversight on Pharmacy Benefit Management processes at Blue Cross NC. Engaging in contract modeling, analytics, and strategic collaboration to enhance pharmacy benefits.
Responsibilities
- Translate complex PBM contractual terms into robust financial/actuarial models, ensuring all contractual requirements are met or exceeded.
- Lead the setup and implementation of new, complex PBM arrangements.
- Perform detailed PBM rebate reconciliations, ensuring accuracy in financial forecasting and payment accuracy.
- Develop and maintain sophisticated models to forecast rebates, analyze pharmacy cost trends, and identify opportunities for savings.
- Work with key stakeholders (Pharmacy Operations, Finance, Legal) to align pharmacy strategy with broader health plan goals.
- Monitor industry news, regulatory changes, and competitive landscape to maintain a competitive position.
- Indirectly manage and mentor less senior actuarial team members, fostering growth in pharmacy financial acumen.
Requirements
- Bachelor's degree or advanced degree (where required)
- Associate of the Society of Actuaries(ASA) and Member of the American Academy of Actuaries (MAAA)
- 5+ years of experience in related field
- In lieu of an ASA, alternate actuarial credentials may be considered.
- In lieu of 5 years of experience, may consider candidates who are Fellows of the Society of Actuaries (FSA).
- Experience with PBM contract negotiation, GPOs, 340b, Pharmacy Network Contracting, and/or Pharmacy Rebate Contracting – Highly Preferred
- Experience with Specialty Pharmacy modeling
- Excellent verbal and written communication skills, with the ability to explain complex financial/actuarial information to non-technical audiences and senior leadership.
- Proven ability to build relationships and work effectively with internal and external partners. – Highly Preferred
- Expert-level knowledge of SAS, SQL, and advanced Excel – Highly Preferred
- Experience building complex financial models.
- Exceptional analytical and creative problem-solving skills.
- Ability to work effectively in a team-based, collaborative environment.
- Self-motivated, resourceful, and able to work independently in a fast-paced, high-growth environment.
Benefits
- Medical, dental, and vision coverage along with numerous health and wellness programs.
- Parental leave and support plus adoption and surrogacy assistance.
- Career development programs and tuition reimbursement for continued education.
- 401k match including an annual company contribution.
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