Manager, Actuarial (ADP)

9025 CVS Shared Services Resources LLC; United States; On-site; USD 93,000 - 204,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking an experienced actuarial professional to support Medicaid pricing evaluation, financial performance management, and strategic decision-making. This role partners with market leadership, finance, and operations to deliver data-driven insights and steer complex pricing initiatives.

You will lead actuarial analyses of state capitation, interpret rate-setting methodologies, and provide oversight to analysts handling large healthcare datasets.

Qualifications

• Bachelor's degree and 3+ years actuarial experience in or adjacent to managed care/health insurance.
• Strong SQL and Excel proficiency; experience with large healthcare datasets.
• Knowledge of actuarial modeling and forecasting techniques.

Responsibilities

• Lead actuarial evaluation of state capitation pricing and forecasting for Medicaid programs.
• Support strategic decision-making with market, product, finance and operations partners.
• Analyze medical cost trends, utilization, enrollment, and financial performance.

Skills

SQL

Excel

Healthcare data

Education

Bachelor's degree

Tools

Power BI

Job description

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

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.

Great benefits for great people

• Medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
• 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.

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.

Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people.

Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.