Manager, Actuarial (ADP)

Summary

CVS Health is a healthcare company focused on creating a more connected, convenient, and compassionate health experience. The Manager, Actuarial will support Medicaid managed care pricing evaluation, financial performance management, and strategic decision-making while providing technical guidance and oversight to actuarial analysts. The role partners with market leadership, finance, and operations stakeholders and develops analyses for complex business questions.

Responsibilities

• Lead actuarial evaluation of state capitation pricing and forecasting for Medicaid managed care programs
• Evaluate and interpret complex state rate-setting methodologies, risk adjustment programs, acuity adjustments, and regulatory requirements
• Assess revenue, medical cost, utilization, and margin drivers to identify emerging trends and business 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
• Evaluate financial impacts of operational and strategic initiatives
• Support development of long-term business strategies through data-driven analysis
• Analyze drivers of medical cost trends, utilization patterns, enrollment changes, and financial performance
• Investigate emerging issues and perform root-cause analyses to explain variances from expectations
• Deliver concise and compelling insights to senior leadership
• Review, challenge, and understand complex analytical methodologies, models, and coding solutions developed by actuarial and analytics teams
• Provide technical oversight and direction to team members working with large healthcare datasets
• Collaborate effectively with analysts and data professionals utilizing SQL and other analytical tools
• Ensure analytical work is appropriately validated, documented, and reproducible
• Provide indirect leadership and mentorship for actuarial team members
• Coordinate work across multiple stakeholders and analytical resources
• Foster accountability, collaboration, and trust with key business partners
• Drive project completion by managing follow-ups, resolving obstacles, and ensuring commitments are met
• Design, build, document, and communicate new analyses to answer evolving business questions
• Identify opportunities to improve existing methodologies, reporting, and analytical processes
• Develop scalable solutions to support increasingly complex business needs

Skills

• Bachelor's degree along with 3+ years of actuarial experience in or adjacent to managed care or health insurance with:
• Strong SQL and Microsoft Excel proficiency
• Experience working with large healthcare datasets
• Knowledge of actuarial modeling and forecasting techniques
• Bachelors degree required
• Experience with actuarial pricing, forecasting, reserving, or financial planning functions
• Experience with healthcare data warehouses and reporting platforms
• Experience assessing and explaining drivers of financial performance
• Strong analytical and problem-solving skills with the ability to manage ambiguity and new or complex business questions
• Proven ability to independently manage multiple priorities and competing deadlines
• Data visualization tools such as Power BI
• Ability to generate new ideas, think strategically, and creatively solve problems that are not well defined
• Excellent written and verbal communication skills

Qualifications

Must Haves

• Bachelor's degree along with 3+ years of actuarial experience in or adjacent to managed care or health insurance with:
• Strong SQL and Microsoft Excel proficiency
• Experience working with large healthcare datasets
• Knowledge of actuarial modeling and forecasting techniques
• Bachelors degree required

Nice to Haves

• Experience with actuarial pricing, forecasting, reserving, or financial planning functions
• Experience with healthcare data warehouses and reporting platforms
• Experience assessing and explaining drivers of financial performance
• Strong analytical and problem-solving skills with the ability to manage ambiguity and new or complex business questions
• Proven ability to independently manage multiple priorities and competing deadlines
• Data visualization tools such as Power BI
• Ability to generate new ideas, think strategically, and creatively solve problems that are not well defined
• Excellent written and verbal communication skills

Benefits

• This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families.
• Medical, dental, and vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources, based on eligibility
• CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.