Sr Actuary - FIN MEU Trend SAI
CVS Pharmacy - Hartford, CT
Apply NowJob Description
Job DescriptionThis position is cross-functional with the evaluation of National Savings Action Initiatives (SAIs) across Commercial, Medicare and Medicaid as well as DUAL and MMP Medical Expense Review (MER) and support. This role will use business acumen to serve as a liaison to multiple lines of business leads and stakeholders in actuarial, clinical services, network, finance, etc. to provide actionable insight in response to medical cost drivers. The candidate will work in a fast-paced, dynamic, and rapidly changing environment and gain exposure to many different areas of the company through collaboration and communication of results. The role combines a dense subject matter expertise with proficient communication skills. Perform complex medical and financial cost analysis to evaluate real time medical cost drivers and develop strategic options and opportunities to favorably impact medical cost in support of Commercial, Medicare (including DUALs and MMP) and Medicaid lines of business. Responsible for planning and forecasting medical costs; developing gross medical trend estimates; developing medical cost action plans; identifying overpayments; analyzing and communicating medical cost changes that impact reserves; providing financial analysis for all types of capitated and fee-for-service provider contracts This position is required to fulfill the Enterprise goals of effective medical cost management in the Medicare Duals line of business (Medicare Duals is an amazing opportunity to get in on the ground floor on the next exciting growth engine for the Enterprise) Provides oversight of all activities related to Medical Economics - Medical Expense Review (MER) team. The primary goal of this team is to provide timely, accurate, actionable data and analysis for utilization and unit cost management in support of the organization's strategic financial strategy. Support the evaluation and implementation of enterprise initiatives to respond to medical cost pressures and mitigate unfavorable drivers of business performance Apply technology to improve business processes and compliance (SQL, Python, SAS, VBA, R, and full suite of Microsoft Office products) and actively participate in the change management process related to emerging technologies and data, specifically the successful launch and adoption of new ADAM (Aetna Date of Service Analytic Model) Cloud platform Interface with senior leadership, describing detailed and intricate data in a way that can be digested by VPs and above. Responsibilities % Time1. Perform complex medical and financial cost analysis to evaluate real time medical cost drivers such as utilization and unit cost metrics, claim payment integrity, vendor analytics, and clinical policy changes directly impacting the healthcare business earnings. Develop strategic options and opportunities to favorably impact medical cost in support of DUAL/MMP lines of business 30%2. Leverage strong analytical and communication skills in evaluating potential medical cost Savings Action Initiatives (SAIs). Share work product and findings with business stakeholders as part of the quarterly/monthly meeting cycles across Finance, Actuarial, and Market Leadership to foster successful collaboration in support of broader enterprise strategy 30%3. Develops and presents actionable recommendations to management based on analysis. 15%4. Collaborates with Medical Management on cost saving opportunities. 10%5. Participates in research-related activities including industry best practices and experience studies. 10%6. Performs other duties as required. 5%Required Qualifications-7+ years of medical cost management and/or benefit design experience -7+ years of experience with insurance regulations -7+ years of data analytical skills and experience -7+ years working in a role with competing priorities and working cross-functionallyCOVID 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 Qualifications-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 stakeholders-Demonstrate initiative, innovation, and leadership in achieving resultsKnowledge of:-Commercial segments and product strategySkill in:-Leading change, developing new content to inform and influence senior business leads and relevant stakeholdersAbility To: -Demonstrate critical thinking and express ideas clearly, concisely, and logically from a cross functional perspectivePrior Relevant Work Experience: 5-8 yearsEducationBachelor's Degree or equivalent experience requiredBachelor's Degree in actuarial science, mathematics, statistics, or other related field preferredBusiness 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: 2024-09-07