Actuarial analyst iii (government programs trend & ai)

Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years, we have been New Jersey’s health solutions leader driving innovations that improve health care quality, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds.

About the Role

This senior level actuary analyst position resides within the Actuarial Department and focuses on Government Programs (Medicare, PDP, DSNP, Medicaid) Trend Forecasting. The role is responsible for supporting the evaluation of proposed benefit and cost-sharing changes, conducting pricing studies, assessing the impact of state and federal legislative changes, and contributing to various actuarial initiatives. The position applies actuarial principles, mathematical modeling techniques, and statistical analysis to evaluate risk and support sound business and pricing decisions.

Additionally, this role serves as a key AI integration partner responsible for driving the adoption and effective use of AI across actuarial trend work. The individual will apply expertise in trend development and identification of key cost and utilization drivers to shape high-value use cases, deliver small-scale AI solutions, advance innovation, monitor adoption outcomes, and escalate misalignment or stalled progress.

What You'll Do

• Assist in the development of forecasted trends.
• Evaluate proposed benefit and cost-sharing changes and assess their financial impact.
• Conduct pricing analyses and studies for product lines of business.
• Analyze the impact of proposed state and federal legislative and regulatory changes.
• Conduct experience studies and detailed analyses to identify cost drivers, utilization patterns, and emerging trends.
• Proactively identifies, shapes, and documents AI use cases in partnership with business unit stakeholders, ensuring proposed opportunities are grounded in business need, aligned to the business unit's strategy.
• Accountable for AI adoption and utilization within the business unit.
• Support additional actuarial projects and initiatives as assigned.
• Collaborate with internal stakeholders and incorporate feedback from cross-functional business partners.
• Prepare reports and presentations that communicate findings, recommendations, and key insights to management.
• Complete ad hoc modeling, forecasting, and analytical projects as needed.

What You Bring

Education/Experience:

• Bachelor's degree required, preferably in Actuarial Science, Mathematics, Statistics, Economics, Data Science, or a related quantitative field.
• Minimum of 4 years of actuarial, statistical, healthcare analytics, or related experience required.
• Progress toward Associate of the Society of Actuaries (ASA) designation is highly preferred.
• Health insurance, healthcare, or managed care experience is preferred.
• Knowledge of artificial intelligence concepts, tools, and platforms at a practical working level, including generative AI, large language models, prompt engineering, AI assistants, and low-code/no-code AI development tools.
• ASA highly preferred.

Additional licensing, certifications, registrations:

• ASA Certification preferred.

Knowledge:

• Advanced proficiency in Microsoft Excel required.
• Experience with SAS, SQL, R, Python, or similar analytical/programming tools preferred.
• Working knowledge of actuarial concepts, data analysis, and statistical methodologies preferred.
• Strong analytical, mathematical, and statistical problem-solving skills.
• Excellent verbal and written communication skills, with the ability to present complex information clearly and effectively.
• Demonstrated critical thinking, sound judgment, and attention to detail.
• Ability to work independently while managing multiple priorities in a deadline-driven environment.

Requires strong mathematical skill and statistical analysis abilities. Requires good judgment and problem solving skills.

Why Horizon?

At Horizon, you’ll do meaningful work that directly improves lives—while being supported by a mission‑driven organization that values expertise, collaboration, and growth. We believe that when our people thrive, our communities do too. If you are passionate about making an impact, we’d love to hear from you!

Salary Range:

$87,300 - $119,070

This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:

• Comprehensive health benefits (Medical/Dental/Vision)
• Retirement Plans
• Generous PTO
• Incentive Plans
• Wellness Programs
• Paid Volunteer Time Off
• Tuition Reimbursement

Disclaimer:

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware. This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.

Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.