Senior Actuarial Analyst - Pharmacy Oversight

Job Description

Blue Cross NC is seeking a Senior Actuarial Analyst - Pharmacy Benefit Oversight to join our growing Pharmacy Analytics team. As a key profit driver for our enterprise, this role offers the opportunity to directly impact our bottom line through strategic Pharmacy Benefit Manager (PBM) oversight. You will leverage your technical acumen to build advanced models, analyze formulary performance, manage pharmacy net cost trends, and provide actionable insights to senior leadership.

• Model Building & Process Improvement: Design, develop, and maintain new actuarial models and analytical processes to evaluate PBM performance, vendor contracts, and pharmacy claims data.
• Formulary Modeling & Strategy: Perform in-depth formulary modeling to drive lowest net cost strategies, optimizing pharmacy benefit offerings for financial and clinical outcomes.
• Trend Management: Actively monitor, analyze, and manage pharmacy net cost trends (ingredient cost, rebate optimization, utilization).
• Data Analytics & Insights: Proactively review advanced data analytic methods and identify opportunities to improve existing team processes.
• Collaboration & Communication: Partner with pharmacy operations, clinical teams, underwriting, and finance to align on assumptions and drive cross-functional value.

• Bachelor's degree or advanced degree (where required)
• 4+ years of experience in relevant actuarial experience. Related experience may be considered.
• Must have completed 5 or more exams towards the eventual attainment of the ASA designation.
• In lieu of meeting minimum exam requirements, may consider additional relevant experience.
• In lieu of meeting minimum experience requirement, may consider ASA or more exams towards the eventual attainment of ASA.

• Expert-level knowledge of SAS, SQL, and advanced Excel - Highly Preferred
• Experience building complex financial models - Highly Preferred
• Proven ability to communicate complex actuarial concepts to non-actuarial stakeholders and senior management.
• Experience with formulary utilization management optimization - Highly Preferred
• Highly organized, detail-oriented, and able to work independently in a fast-paced environment.
• Strong critical thinking and creative problem-solving skills.

• The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community.
• Work-life balance, flexibility, and the autonomy to do great work.
• 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
• Learn more

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.

* Based on annual corporate goal achievement and individual performance.

$98,092.00 - $

Actuarial Analysis, Actuarial Consulting, Actuarial Science, Business Analysis, Complex Project Management, Financial Modeling, Hiring Management, People Management, Risk Assessments, Valuation Analysis