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Position Summary
We are seeking an experienced actuarial professional to support Medicaid managed care pricing evaluation, financial performance management, and strategic decision-making. This role requires a strong combination of actuarial expertise, business acumen, technical proficiency, and leadership capability. The successful candidate will serve as a key partner to market leadership, finance, and operational stakeholders while providing guidance and oversight to actuarial analysts supporting complex Medicaid markets.

This position is ideal for an actuary with strong project management skills who can balance short-term deliverables and ad hoc requests with long-term strategic initiatives, thrive in a dynamic environment, and independently develop analyses to address emerging business questions.

Medicaid Pricing and Actuarial Analysis

• Lead actuarial evaluation of state capitation pricing and forecasting for Medicaid managed care programs.

• Evaluate and interpret complex state rate-setting methodologies, risk adjustment programs, acuity adjustments, and regulatory requirements.

• Assess revenue, medical cost, utilization, and margin drivers to identify emerging trends and business risks.

• Summarize and communicate actuarial analysis for business leadership. Strategic Business Support

• Partner with market, product, finance, and operations teams to support strategic decision-making.

• Provide insight into Medicaid market dynamics, state policy changes, competitive positioning, and business performance.

• Evaluate financial impacts of operational and strategic initiatives.

• Support development of long-term business strategies through data-driven analysis.

Performance Monitoring and Trend Analysis

• Analyze drivers of medical cost trends, utilization patterns, enrollment changes, and financial performance.

• Investigate emerging issues and perform root-cause analyses to explain variances from expectations.

• Deliver concise and compelling insights to senior leadership. Technical Leadership

• Review, challenge, and understand complex analytical methodologies, models, and coding solutions developed by actuarial and analytics teams.

• Provide technical oversight and direction to team members working with large healthcare datasets.

• Collaborate effectively with analysts and data professionals utilizing SQL and other analytical tools.

• Ensure analytical work is appropriately validated, documented, and reproducible.

Team Leadership and Collaboration

• Provide indirect leadership and mentorship for actuarial team members.

• Coordinate work across multiple stakeholders and analytical resources.

Foster accountability, collaboration, and trust with key business partners.

• Drive project completion by managing follow-ups, resolving obstacles, and ensuring

commitments are met.

Innovation & Process Improvement

• Design, build, document, and communicate new analyses to answer evolving business

questions.

• Identify opportunities to improve existing methodologies, reporting, and analytical processes.

• Develop scalable solutions to support increasingly complex business needs.

Required Qualifications
Bachelor's degree along with 3+ years of actuarial experience in or adjacent to managed care or health insurance with:

• Strong SQL and Microsoft Excel proficiency.

• Experience working with large healthcare datasets.

• Knowledge of actuarial modeling and forecasting techniques.

Preferred Qualifications
• Experience with actuarial pricing, forecasting, reserving, or financial planning functions.

• Experience with healthcare data warehouses and reporting platforms.

• Experience assessing and explaining drivers of financial performance.

• Strong analytical and problem-solving skills with the ability to manage ambiguity and new or

complex business questions.

• Proven ability to independently manage multiple priorities and competing deadlines.

• Data visualization tools such as Power BI.

• Ability to generate new ideas, think strategically, and creatively solve problems that are not

well defined.

• Excellent written and verbal communication skills.

Education
Bachelors degree required.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$92,700.00 - $203,940.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
 

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 10/19/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.