Principal Actuary – Pharmacy Benefit Manager (PBM) Oversight
WFA Digital Insight
The demand for skilled actuaries in the healthcare sector has grown significantly, with a 25% increase in job postings over the past year. As the pharmacy benefits landscape continues to evolve, companies like Blue Cross NC are seeking experts who can navigate complex contractual requirements and drive value through data-driven insights. With the rise of remote work, professionals can now access these opportunities from anywhere, but they must possess a unique blend of technical expertise, business acumen, and communication skills. Candidates should be aware that this role requires a deep understanding of actuarial principles, Excel, and the ability to collaborate with cross-functional teams. Before applying, it's essential to highlight relevant experience and certifications, such as ASA or MAAA, to stand out in a competitive job market.
Job Description
About the Role
The Principal Actuary position at Blue Cross NC is a critical component of the Pharmacy Analytics team, responsible for overseeing the company's Pharmacy Benefit Manager (PBM) contracts. This role involves translating complex contractual terms into actionable financial models, ensuring that all requirements are met or exceeded. The successful candidate will work closely with internal pharmacy leadership and external partners to drive value through rigorous analytics and maintain a competitive position in the dynamic marketplace.As a key member of the team, the Principal Actuary will be responsible for standing up new, innovative, and complex PBM arrangements, performing detailed rebate reconciliations, and developing sophisticated models to forecast rebates and analyze pharmacy cost trends. This role requires a high level of technical expertise, business acumen, and communication skills, as well as the ability to work effectively with cross-functional teams.
The Principal Actuary will also have the opportunity to mentor less senior actuarial team members, fostering growth in pharmacy financial acumen and contributing to the company's overall success.
What You Will Do
- Translate complex PBM contractual terms into robust financial and actuarial models
- Stand up new, innovative, and complex PBM arrangements
- Perform detailed PBM rebate reconciliations to ensure accuracy in financial forecasting and payment accuracy
- Develop and maintain sophisticated models to forecast rebates, analyze pharmacy cost trends, and identify opportunities for savings
- Collaborate with key stakeholders, including Pharmacy Operations, Finance, and Legal, to align pharmacy strategy with broader health plan goals
- Monitor industry news, regulatory changes, and competitive landscape to maintain a competitive position
- Mentor less senior actuarial team members to foster growth in pharmacy financial acumen
- Work closely with internal pharmacy leadership and external partners to drive value through rigorous analytics
- Develop and implement strategic initiatives to improve pharmacy benefits and overall health plan performance
What We Are Looking For
- Bachelor's degree or advanced degree in a relevant field
- Associate of the Society of Actuaries (ASA) and Member of the American Academy of Actuaries (MAAA)
- 5+ years of experience in a related field, or equivalent actuarial credentials
- Expert-level knowledge of Excel and advanced analytical skills
- Experience with PBM contract negotiation, GPOs, 340b, Pharmacy Network Contracting, and/or Pharmacy Rebate Contracting (highly preferred)
- Excellent verbal and written communication skills, with the ability to explain complex financial and actuarial information to non-technical audiences and senior leadership
- Proven ability to build relationships and work effectively with internal and external partners
Nice to Have
- Experience with Specialty Pharmacy modeling
- Expert-level knowledge of SAS, SQL, and advanced Excel
- Experience building complex financial models
- Exceptional analytical and creative problem-solving skills
- Ability to work effectively in a team-based, collaborative environment
Benefits and Perks
- The opportunity to work at the cutting edge of healthcare delivery with a team that's deeply invested in the community
- Work-life balance, flexibility, and 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
- Competitive health benefits and wellness programs
- Opportunity for professional growth and development in a dynamic and growing company
How to Stand Out
- Develop a strong understanding of actuarial principles and Excel to stand out in this role
- Highlight relevant experience and certifications, such as ASA or MAAA, to demonstrate expertise
- Be prepared to explain complex financial and actuarial concepts to non-technical audiences and senior leadership
- Showcase your ability to work effectively with cross-functional teams and build relationships with internal and external partners
- Consider developing a portfolio of your work, including complex financial models and analytical projects, to demonstrate your skills
- Be prepared to discuss your experience with PBM contract negotiation, GPOs, 340b, Pharmacy Network Contracting, and/or Pharmacy Rebate Contracting
- Research the company's culture and values to demonstrate your fit and enthusiasm for the role
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