Medicaid Actuarial Lead – Pricing & Strategy

CVS Health Corporation; Hartford (CT); On-site; USD 93,000 - 204,000; Full time

Benefits offered by this job

Medical, Dental, and Vision coverage

Paid time off

Retirement savings options

Wellness programs

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. Lead actuarial analyses and partner with cross-functional teams to drive insights for senior leadership.

The role emphasizes project management, data-driven decision-making, and independent analysis development in a dynamic healthcare environment.

Qualifications

• Bachelor's degree plus 3+ years of actuarial experience in or adjacent to 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 and interpret state 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.
• Provide insight into Medicaid market dynamics, state policy changes, and performance.
• Impact financials of operational and strategic initiatives; support long-term business strategies with data-driven analysis.
• Provide indirect leadership and mentorship for actuarial team members; coordinate work across stakeholders.

Skills

SQL

Excel

Actuarial modeling

Education

Bachelor's degree

Tools

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. Lead actuarial analyses and partner with cross-functional teams to drive insights for senior leadership.

The role emphasizes project management, data-driven decision-making, and independent analysis development in a dynamic healthcare environment.