Medicaid Actuarial Lead — Pricing & Strategy Analytics

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

Benefits offered by this job

Medical insurance

Dental insurance

Vision coverage

Paid time off

Retirement savings

Wellness programs

Job summary

CVS Health Corporation is seeking an experienced actuarial professional to support Medicaid managed care pricing evaluation, financial performance, and strategic decision‑making. Lead actuarial analyses, guide analysts, and collaborate with market leadership to drive data‑driven decisions.

The role requires strong SQL/Excel, experience with large healthcare datasets, and the ability to balance short-term requests with long‑term initiatives. 40 hours/week, full‑time, Irving, TX.

Qualifications

• Bachelor's degree required.
• 3+ years 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.
• Interpret state rate-setting methodologies, risk adjustment, acuity adjustments, and regulations.
• Assess revenue, medical cost, utilization and margin drivers for trends and risks.
• Summarize and communicate analyses to business leadership.
• Partner with market, product, finance, and operations teams for strategic decisions.
• Provide insight into Medicaid market dynamics, policy changes, and performance.
• Evaluate financial impacts of operational and strategic initiatives.
• Support development of long-term business strategies via data-driven analyses.
• Analyze drivers of medical cost trends, utilization, and enrollment changes.
• Investigate issues and perform root-cause analyses for variances.
• Deliver concise insights to senior leadership.
• Review and guide complex analytical methodologies and models.
• Provide technical direction to teams handling large datasets.
• Collaborate with analysts using SQL and other tools; ensure reproducibility.
• Foster accountability and collaboration with key business partners.
• Design and communicate new analyses to answer evolving questions.
• Identify opportunities to improve methodologies, reporting, and processes.

Skills

SQL

Excel

Healthcare datasets

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, and strategic decision‑making. Lead actuarial analyses, guide analysts, and collaborate with market leadership to drive data‑driven decisions.

The role requires strong SQL/Excel, experience with large healthcare datasets, and the ability to balance short-term requests with long‑term initiatives. 40 hours/week, full‑time, Irving, TX.