Senior Actuarial Manager

Job DescriptionThis role will support local market network teams on the implementation and administration of Value Based Contracting (VBC) agreements for our full risk Medicare Advantage partnerships. The right candidate will be responsible for the day-to-day oversight of a small team in developing and executing a comprehensive support strategy for our most visible full risk Medicare VBC partners and evaluate contract performance using actuarial sound principals.As part of the Medical Economics Team, you will take ownership and collaborate with internal partners to develop best in class solutions to ensure providers partners have the needed analytic support to drive growth and performance while meeting our contractual commitments. You will lead enhancements projects and project manage process improvements across the enterprise. You will serve as a SME on complex questions and strategy decision and your team will be responsible to guide and train market facing team members as needed. Candidate would also handle additional tasks as directed by supervisor or manager.Candidate will prepare and deliver complex, high profile actuarial work to senior leadership pertaining to VBC performance. Ideal candidate will be comfortable with developing creative solutions for non standard requests and communicating outcomes successfully.The larger Medical Economics Team is accountable for analysis of medical costs across lines of business, supporting data for the right pricing and to develop Medical cost savings initiatives. We partner with a wide range of business units across the enterprise including other Medical Economics areas and Contract Negotiators.Required Qualifications5 or more years of Medicare Advantage and/or med-cost analytics experienceCOVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred QualificationsReimbursement strategies for Value-Based contracting particularly for MedicareExperience with reserving/pricing of Medicare businessMedical cost analytics for value-based populationsSQL development or familiarity with relational databasesLeading change, developing new content to inform and influence senior business leads and relevant stakeholdersDemonstrate critical thinking and express ideas clearly, concisely, and logically from a cross functional perspective.Demonstrated success in providing strong technical guidance and leadership direction.Demonstrated success in collaborating with others to meet/exceed expectations.Experience working with standard Microsoft Office product.Key managed care functions including provider contracting, benefit design, medical management as well as knowledge of business functions and impact on financials (underwriting, sales, product development, network management)Expertise analytical and problem-solving skills Strong organizational, management and leadership skills Excellent written and verbal communication and presentation skills. Leading change, developing new content to inform and influence senior business leads and relevant stakeholdersManage conflicting priorities and multiple projects concurrently. Demonstrate initiative, innovation, and leadership in achieving resultsDemonstrates critical thinking and expresses ideas clearly, concisely, and logically from a cross functional perspective.Member of the American Academy of Actuaries certificationEducationBachelor's Degree or equivalent work experience.Business OverviewBring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Created: 2024-11-02