Senior Actuarial Manager, Medicaid Pricing & Strategy

CVS Pharmacy; Columbus (OH); 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

Job summary

CVS Health is seeking an experienced actuarial professional to support Medicaid managed care pricing evaluation, financial performance management, and strategic decision-making. The role partners with market leadership, finance, and operations to oversee complex Medicaid analyses and guide business choices.

Responsibilities include leading capitation pricing evaluations, assessing rate-setting methodologies, and delivering concise insights to senior leadership.

Qualifications

• 3+ years actuarial experience in or adjacent to managed care or health insurance.
• Strong SQL and Microsoft Excel proficiency.
• Experience 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 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.
• Analyze drivers of medical cost trends, utilization patterns, enrollment changes, and financial performance.
• Deliver concise and compelling insights to senior leadership.

Skills

SQL proficiency

Excel proficiency

Analytical thinking

Communication skills

Education

Bachelor’s degree

Tools

SQL

Microsoft Excel

Power BI

Job description

CVS Health is seeking an experienced actuarial professional to support Medicaid managed care pricing evaluation, financial performance management, and strategic decision-making. The role partners with market leadership, finance, and operations to oversee complex Medicaid analyses and guide business choices.

Responsibilities include leading capitation pricing evaluations, assessing rate-setting methodologies, and delivering concise insights to senior leadership.