Actuarial Analyst II (Medicare Part D)

Actuarial Analyst II (Medicare Part D) at Independence Blue Cross LLC Actuarial Analyst II (Medicare Part D) at Independence Blue Cross LLC in Philadelphia, Pennsylvania Posted in 10 days ago.

Type:

Full-Time Job Description:

Bring your drive for excellence, teamwork, and customer commitment to Independence. Join us as we renew and reimagine the future of health care. Together, we will achieve our mission to enhance the health and well-being of the people and communities we serve. We are seeking an actuarial professional with a background in Medicare Part D pricing to join our Government Markets team. This role will have meaningful responsibility for the development and ongoing enhancement of Part D pricing models, with increasing ownership over time. Ideal candidates will have hands-on experience with Medicare Part D bid development or prior pharmacy experience.

Key Responsibilities:

Design, build, and maintain Part D pricing models to project member-level drug utilization, cost sharing, plan liability, and CMS payments. Translate Part D benefit designs, formularies, and CMS rules into detailed model logic. Perform reconciliation of model results to aggregate bid components and financial reporting. Work directly with raw claims and enrollment data to support model inputs, assumptions, and calibration. Support scenario testing (e.g. benefit changes, trend, risk mix) and customer level pricing using seriatim projections. Collaborate with cross-functional teams, including finance, underwriting, and product development, in support of pricing analyses and corporate strategy and forecasts. Monitor regulatory changes and assess their impact on pricing and profitability. Present findings and recommendations to the Actuarial Manager. Document model logic, assumptions, and validation results.

Qualifications:

Bachelor's degree in Actuarial Science, Mathematics, Statistics, or a related field. 2+ years of actuarial experience, with a focus on Medicare Part D pricing or pharmacy. Completion of 4+ actuarial exams. Experience working with detailed healthcare claims data. Proficiency in Excel and

SQL. R/SAS

experience preferred. Excellent communication and collaboration skills.

Preferred Experience:

Prior experience with Part D pricing models, claim-level analytics, or seriatim forecasting. Demonstrated ability to work independently and drive projects forward with minimal oversight. Proven track record of taking initiative, managing competing priorities, and delivering high-quality work in a deadline-driven environment. Independence has implemented a "Hybrid" model which consists of Associates working in the office 3 days a week (Tuesday, Wednesday & Thursday) and remotely 2 days a week (Monday & Friday). This role is designated as a role that fits into the "Hybrid" model. While associates may work remotely on our designated remote days, the work must be performed in the Tri-State Area of Delaware, New Jersey, or Pennsylvania. IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability. Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.