Medicaid Actuarial Lead - Pricing & Strategy

CVS Health Corporation; Center Square (PA); On-site; USD 93,000 - 204,000; Full time

Job summary

CVS Health Corporation is seeking an experienced actuarial professional to support Medicaid managed care pricing evaluation, financial performance management, and strategic decision‑making. This role requires a strong balance of actuarial expertise, business acumen, and leadership to guide analyses for senior stakeholders.

The ideal candidate will lead pricing evaluations, monitor performance, and partner with finance, operations and market teams to address evolving Medicaid dynamics and

Qualifications

• Bachelor's degree required with 3+ years actuarial experience in managed care or health insurance.
• Strong SQL and Microsoft Excel proficiency.
• Experience working with large healthcare datasets.
• Knowledge of actuarial modeling and forecasting techniques.

Responsibilities

• Lead actuarial evaluation of state capitation pricing and forecasting for Medicaid managed care programs.
• Evaluate rate-setting methodologies, risk adjustment programs, acuity adjustments, and regulatory requirements.
• Assess revenue, medical cost, utilization, and margin drivers to identify trends and risks.
• Summarize and communicate actuarial analysis for business leadership.
• Partner with market, product, finance, and operations teams to support strategic decisions.

Skills

Actuarial modeling

Forecasting techniques

Analytical skills

Education

Bachelor's degree

Tools

SQL

Microsoft Excel

Power BI

Job description

CVS Health Corporation is seeking an experienced actuarial professional to support Medicaid managed care pricing evaluation, financial performance management, and strategic decision‑making. This role requires a strong balance of actuarial expertise, business acumen, and leadership to guide analyses for senior stakeholders.

The ideal candidate will lead pricing evaluations, monitor performance, and partner with finance, operations and market teams to address evolving Medicaid dynamics and