Pharmacy Contracting RFP Pricing Actuary

Humana Inc; United States; Remote; USD 129,000 - 178,000; Full time

Job summary

Humana Inc. is seeking an Actuary for its Analytics/Forecasting department. In this critical role, you'll be responsible for setting pricing assumptions, analyzing market trends, and developing pricing tools to meet profit goals for CenterWell Pharmacy. This opportunity requires strong analytical skills, leadership capabilities, and a solid background in actuarial practices. Join a company that values health and community, offering competitive benefits and support for professional development.

Benefits

401(k) retirement savings plan

Medical, dental, and vision benefits

Paid time off and holidays

Short-term and long-term disability

Life insurance

Qualifications

• Bachelor's degree is required.
• FSA or ASA with relevant experience is preferred.
• Experience in multiple functions such as modeling and pricing.

Responsibilities

• Develop pricing methodologies and tools to enhance pharmacy profitability.
• Analyze market levels and recommend pricing actions to improve competitiveness.
• Support senior leaders and manage a team of 2-3 direct reports.

Skills

Strong communication skills

SAS/SQL knowledge

Education

Bachelor's Degree

FSA or ASA plus relevant advanced degree

MAAA

Tools

Power BI

Job description

Become a part of our caring community and help us put health first

The Actuary, Analytics/Forecasting is responsible for setting pricing assumptions, submitting RFPs, and monitoring performance of our CenterWell Pharmacy payer agnostic business. This role will support senior leaders in developing our pricing methodologies and sales to external payers. Develops and maintains pricing tools that price standard, cost+, and spread options. The Actuary, Analytics/Forecasting works on problems of diverse scope and complexity ranging from moderate to substantial.

The Actuary, Analytics/Forecasting establishes market level financial metrics to align with CenterWell Pharmacy profitability goals, analyzes market level results and projections, and develops recommended pricing actions to address gaps to targeted metrics to expand our external volumes. It researches and understands competitors in the marketplace and advises CWP and CWSP leadership in developing strategies to increase competitiveness and grow profit for the pharmacy. The role exercises independent judgment and decision making on complex issues regarding job duties and related tasks and works under minimal supervision, uses independent judgment requiring analysis of variable factors and determining the best course of action. This role is expected to have 2-3 direct reports and needs to balance the above priorities across the team to meet objectives and deadlines.

Use your skills to make an impact

Required Qualifications

• Bachelor's Degree
• FSA or ASA plus relevant advanced degree, recent and relevant work experience, and/or other relevant professional designations.
• MAAA
• Strong communication skills
• Experience in more than two functions (e.g., modeling, pricing, rate filing, reporting & analysis, reserving or trending)
• SAS/SQL knowledge
• Consulting and influencing senior leadership

Preferred Qualifications

• People leader experience
• Power BI or other visualization software
• Modeling and developing proposals for pharmacy bids
• Pharmacy pricing experience
• Experience working with available industry third-party pharmacy utilization data
• Tracking actuals vs expected and explaining drivers of variance
• Identification and tracking of KPIs
• Explaining complex topics to non-technical audiences

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$129,300 - $177,800 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: 06-17-2025

About us

About CenterWell Pharmacy: CenterWell Pharmacy provides convenient, safe, reliable pharmacy services and is committed to excellence and quality. Through our home delivery and over-the-counter fulfillment services, specialty, and retail pharmacy locations, we provide customers simple, integrated solutions every time. We care for patients with chronic and complex illnesses, as well as offer personalized clinical and educational services to improve health outcomes and drive superior medication adherence.About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation’s largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first – for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.