Actuary - Medicare Part D - Evernorth - Remote

Cigna; Bloomfield (NJ); Remote; USD 109,000 - 183,000; Full time

Job summary

A health services company based in Bloomfield, NJ is seeking an experienced actuarial analyst to provide support for Medicare Part D programs. You will develop analytical products, perform financial analyses, and collaborate with internal and external partners. The ideal candidate has a strong actuarial background and familiarity with Medicare regulations. Competitive salary and benefits are offered to the right individual.

Benefits

Comprehensive benefits package including medical, vision, and dental

401(k) with company match

Tuition reimbursement

Paid time off and holidays

Qualifications

• 5+ years of actuarial experience or 3+ years of consulting experience required.
• ASA (or near ASA) strongly preferred; FSA preferred.
• Regulated Markets Medicare Part D experience is preferred.

Responsibilities

• Co-lead development of actuarial analytics products for Part D Plans.
• Perform financial analyses of proposed regulatory changes.
• Collaborate with partners to determine operational feasibility.

Skills

Modeling

Forecasting

Predictive analytics

Communication

SQL

R

SAS

Python

Education

Bachelor's degree in Actuarial Science, Economics, Statistics, Finance or other quantitative field

Job description

Overview

This position provides external actuarial analytics support within the regulated Medicare market and Pharmacy Benefit Manager (PBM) Healthplan space, dedicated to Express-Scripts' external Medicare Part D business. The role collaborates with internal leadership across trend, formulary, clinical, knowledge solutions, sales & account management, and supply teams to develop actuarial analyses for Medicare Part D programs, including CMS programs, drug expense analyses and projections, financial forecasts, actuarial modeling, pharmacy network optimization, rebates optimization, regulatory impact assessment, and ad hoc analyses.

The position requires an experienced strategic viewpoint across a wide range of actuarial prescription drug subjects within the enterprise, industry, and regulatory environments.

Responsibilities

Essential Responsibilities of the Role include:

Product Support / Development

• Co-lead development of actuarial analytics products for Express Scripts existing Part D Plans
• Perform financial analyses of proposed regulatory changes, demonstration programs, and other CMS programs to determine financial impact on entities within the drug supply chain
• Develop actuarial models for prospective projections of plan liability and premium impact sensitivities for Medicare Part D Plan clients
• Build actuarial models and project management functions to accelerate and safeguard improvements in analytics tools to identify gaps in the Medicare Part D market
• Lead studies to identify gaps in the Medicare Part D Prescription Drug Health market and develop strategies to close those gaps

Analytics Support to Part D Plans

• Drive strategic discussions to develop analytics road map to optimize Part-D revenue and cost-reduction strategies for Medicare Part D Health Plans (PDP, MAPD, SNPs)
• Review Part D Plan bid assumptions for Regulated Medicare Part D Health Plans
• Create analytics for Part D bids substantiation for Desk Review and Part D audits
• Utilize independent judgment to perform complex customized actuarial analyses for Part D Health Plans

Cross-Functional Financial Support

• Collaborate with internal Express-Scripts partners and external vendors to determine operational feasibility and financial ramifications of special programs
• Apply Part D subject matter expertise to facilitate analytics capabilities, measure performance, and create actionable insights for technical teams within Express-Scripts
• Collaborate within the enterprise on Medicare Part D financial and operational strategy development, including: advanced trend analytics; MLR / member profitability projections; formulary strategy; clinical analytics around prescription drugs; out-of-pocket costs; member risk score analysis; regulatory impact quantification; and financial reconciliation support

• Assimilate macro and micro trends, develop benchmarks, and gather competitive intelligence to inform market strategies
• Train and educate non-actuarial internal teams on Medicare Part D market financial and analytics components

Qualifications

• Bachelor's degree in Actuarial Science, Economics, Statistics, Finance or other quantitative field strongly preferred
• 5+ years of actuarial experience or 3+ years of consulting experience
• ASA (or near ASA) strongly preferred; FSA preferred
• Part D Prescription Drug or Part D bid development consulting experience preferred
• Regulated Markets Medicare Part D experience; PBM/healthcare/pharma experience preferred; consulting experience strongly preferred
• Track record of managing multiple projects and teams that deliver client-driven growth
• Proven capabilities in modeling, forecasting, and predictive analytics
• Strong communication and presentation skills; written/verbal proficiency
• Coding skills in SQL, R, SAS, or Python strongly preferred
• Extensive understanding of US prescription drug supply chain and Medicare Part D knowledge is preferred, including but not limited to: bid development, desk review & audits, regulatory compliance, financial reconciliation modeling, trend analyses, formulary modeling, network optimization modeling, rebates modeling, market landscape analytics, and risk score modeling

• Ability to gather and analyze information, map and execute growth strategies for existing and new business
• Ability to structure ambiguous actuarial and financial analyses and communicate complex results in clear, data-driven takeaways for senior leadership

Work Arrangements

If you will be working from home occasionally or permanently, internet service must be provided by a broadband or fiber connection with speeds of at least 10 Mbps download/5 Mbps upload.

Compensation and Benefits

This position offers an annual salary ranging from $109,400 to $182,300 USD, depending on experience and geographic location. Eligibility for participation in an annual bonus plan is anticipated. A comprehensive benefits package includes medical, vision, dental, well-being and behavioral health programs, 401(k) with company match, company-paid life insurance, tuition reimbursement, at least 18 days of paid time off per year, and paid holidays. Details are available under Life at Cigna Group.

About Evernorth Health Services

Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care, and benefit solutions to improve health and vitality. We drive growth and improve lives by innovating to make prevention and treatment more accessible.

EEO and Accommodation

Qualified applicants will be considered without regard to race, color, age, disability, sex, pregnancy, or related medical conditions including lactation, sexual orientation, gender identity or expression, veteran status, religion, national origin, ancestry, marital or familial status, genetic information, public assistance status, citizenship status, or any other characteristic protected by applicable EEO laws. If you require reasonable accommodation in completing the online application process, please email [e-mail] for support. Do not email for updates on your application. The Cigna Group maintains a tobacco-free policy and may restrict hiring tobacco/nicotine users where legally permissible. Applicants with criminal histories will be considered consistent with federal, state, and local laws.