Medicaid Actuarial Leader: Pricing & Strategy

CVS Health Corporation; Woonsocket (RI); 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

Bonus eligibility

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 partners with market leadership, finance, and operations while guiding actuarial analysts in complex Medicaid markets.

The ideal candidate will drive actuarial evaluation of state capitation pricing, assess rate-setting methodologies, and deliver concise insights to senior leadership.

Qualifications

• Bachelor's degree plus 3+ years actuarial experience in or adjacent to managed care/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 complex 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 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.
• 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.
• Review, challenge, and understand complex analytical methodologies, models, and coding solutions.
• 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.
• Provide indirect leadership and mentorship for actuarial team members.
• Coordinate work across multiple stakeholders and analytical resources.
• Drive project completion by managing follow-ups, resolving obstacles, and ensuring commitments are met.
• Foster accountability, collaboration, and trust with key business partners.
• 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.

Skills

SQL

Excel

Actuarial modeling

Analytical skills

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. This role partners with market leadership, finance, and operations while guiding actuarial analysts in complex Medicaid markets.

The ideal candidate will drive actuarial evaluation of state capitation pricing, assess rate-setting methodologies, and deliver concise insights to senior leadership.