Actuarial Development Program Jobs in Raleigh, NC

Job Description

Leads enterprise efforts supporting the design, operationalization, and optimization of value-based care programs across the full operational lifecycle. The Principal Value-Based Care Operations Advisor provides subject matter expertise spanning program design, contract execution, performance measurement, operational workflows, and financial reconciliation to ensure value-based care initiatives achieve intended clinical, financial, and operational outcomes.
This role partners across clinical, network, finance, actuarial, analytics, and operational teams to translate strategic value-based care objectives into scalable operating models. The position drives alignment across federated stakeholders and ensures programs are operationally executable, measurable, and sustainable.

What You Will Do

• Lead end-to-end operational design of value-based care programs, including shared savings, downside risk, and alternative payment models.

• Translate strategic program objectives into operational workflows, governance structures, and execution plans.

• Identify operational gaps across contracting, attribution, performance measurement, reporting, and financial settlement processes.

• Partner with clinical, finance, actuarial, analytics, and network teams to ensure alignment between program design and operational execution.

• Support development and refinement of VBC operating models and cross-functional processes.

• Evaluate program performance drivers and recommend operational improvements to enhance outcomes and financial sustainability.

• Provide expertise supporting implementation of new reimbursement models and provider partnership strategies.

• Lead complex cross-functional initiatives requiring coordination across enterprise stakeholders and external partners.

• Support provider engagement strategies by ensuring operational readiness and clarity of performance expectations.

• Establish repeatable processes and controls supporting program scalability and measurement integrity.

• Identify risks to program execution and develop mitigation strategies across operational domains.

• Present operational insights, performance implications, and strategic recommendations to senior leadership.

• Serve as a subject matter expert for value-based care operations and enterprise transformation initiatives.

• Mentor and guide team members supporting value-based care program delivery.

What You Bring

• Bachelor's degree or advanced degree in healthcare administration, business, public health, or related field.

• 8+ years of experience in healthcare operations, value-based care programs, payer-provider strategy, or healthcare consulting.

• Demonstrated experience supporting or operating value-based care models including total cost of care or risk-based arrangements.

• Experience working across multiple healthcare domains including clinical operations, finance, analytics, and network/provider engagement.

• Strong understanding of healthcare reimbursement and performance measurement concepts.

In lieu of degree:10+ years of directly related healthcare experience.

Preferred Qualifications

• Experience operationalizing Medicare Advantage and Commercial VBC programs.

• Experience supporting shared savings reconciliation or financial settlement processes.

• Familiarity with attribution methodologies, performance measurement frameworks, and population health analytics.

• Experience working within payer organizations or integrated delivery systems.

• Consulting or enterprise transformation experience supporting healthcare operating model design.

• This role provides operational leadership ensuring value-based care strategies translate into executable and sustainable programs. The position bridges strategy and execution by aligning program design, operational workflows, and performance measurement across enterprise stakeholders.

• The Principal Value-Based Care Operations Advisor focuses on operational execution and program performance and does not function as a project management or reporting role.

#LI-Hybrid

Salary Range

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.

$130,560.00 - $208,896.00

Skills

Healthcare Operations, Healthcare Process Improvement, Healthcare Reimbursement, Operational Efficiency, Operational Process Improvements, People Management, Project Management, Provider Reimbursement, Reporting and Analysis, Strategic Planning

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