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Manager, Actuarial
CVS Health. Lead actuarial evaluation of state capitation pricing and forecasting for Medicaid managed care programs .
Tech Stack
Tools & technologiesSQL
About the role
Key responsibilities & impact- 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 business risks
- Summarize and communicate actuarial analysis for business leadership
- Partner with market, product, finance, and operations teams on 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 long-term business strategies through data-driven analysis
- Analyze medical cost trends, utilization patterns, enrollment changes, and financial performance
- Investigate emerging issues and perform root-cause analyses
- Deliver insights to senior leadership
- Review and provide technical oversight for analytical methodologies, models, and coding solutions
- Guide team members working with large healthcare datasets and analytical tools
- Ensure analytical work is validated, documented, and reproducible
- Provide indirect leadership and mentorship to actuarial team members
- Coordinate work across stakeholders and analytical resources
- Manage follow-ups, resolve obstacles, and drive project completion
- Design, build, document, and communicate analyses for evolving business questions
- Improve methodologies, reporting, and analytical processes
- Develop scalable solutions for increasingly complex business needs
Requirements
What you’ll need- Bachelor's degree required
- 3+ years of actuarial experience in or adjacent to managed care or health insurance
- Strong SQL proficiency
- Strong Microsoft Excel proficiency
- Experience working with large healthcare datasets
- Knowledge of actuarial modeling and forecasting techniques
- Preferred: experience with actuarial pricing, forecasting, reserving, or financial planning functions
- Preferred: experience with healthcare data warehouses and reporting platforms
- Preferred: experience assessing and explaining drivers of financial performance
- Preferred: strong analytical and problem-solving skills
- Preferred: ability to manage ambiguity and new or complex business questions
- Preferred: ability to independently manage multiple priorities and competing deadlines
- Preferred: experience with data visualization tools such as Power BI
- Preferred: ability to generate new ideas, think strategically, and creatively solve poorly defined problems
- Preferred: excellent written and verbal communication skills
Benefits
Comp & perks- CVS Health bonus, commission or short-term incentive program in addition to base pay
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being