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Position Summary

Provides oversight of actuarial functions within our Healthcare Delivery businesses. Works in close collaboration with business actuaries, finance, and business leaders to ensure financial integrity of strategies, forecasts, pricing models, and provider performance tools. Supports oversight and peer review of national outside actuarial firms. Manages a senior analyst and collaborates with business actuaries and members of the enterprise pricing team.

For our provider enablement business (CVS Accountable Care, including ACO Reach and MSSP):

• Collaborates with business actuaries in the oversight of national outside actuarial firms to ensure integrity of forecasts and pricing tools and development of independent internal financial projections

• Works with business actuaries to leverage tools of outside actuarial firms to develop high quality forecasting and provider performance internal models

• Collaborates with finance to ensure the financial integrity of business strategies, forecasts and risk contracts

• Works with business actuaries and business leaders to drive the run rate performance of our provider partners to achieve our financial commitments; identifies areas where performance is not on plan and develops remediation plans that can be executed and tracked

• Stays current with regulatory changes that impact benchmark reimbursement, contract structure, and other financial levers of the business; develops strategies to optimize financial results

For our Medicare Advantage provider-based business (Oak Street Health and value-based services):

• Supports evaluation of medical trends, revenue coding accuracy, payor performance, and adequacy of payor reimbursement; identifies areas to improve run rate performance of the business

• Stays current with regulatory changes that impact CMS reimbursement levels, bidding strategies, and additional liabilities for MAPD and advises management in ways to optimize financial results

• Collaborates with business partners and finance in the financial evaluation of new strategic directions, including clinical programs

Required Qualifications

• 15+ years of actuarial work and leadership
• Experience in actuarial aspects of Traditional Medicare FFS programs or Medicare Advantage
• Experience in leadership of others in broad-based problem solving to an improved financial outcome
• Experience in effectiveness communicating complex concepts and driving consensus among stakeholders
• Experience in execution and delivery (planning, delivering, and supporting) skills
• Experience in business intelligence
• Experience in collaboration and teamwork
• Experience in growth mindset (agility and developing yourself and others) skills
• FSA or ASA (Fellow of the Society of Actuaries or Associate of the Society of Actuaries)

Preferred Qualifications

• Actuarial leadership experience with provider delivery and enablement systems and traditional Medicare Fee-for-Service (FFS) programs, e.g., ACO Reach and MSSP
• Ability to work Hybrid Model (in office Tuesday / Wednesday /Thursday)

Pay Range

The typical pay range for this role is:

$131,500.00 - $303,200.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.  This position also includes an award target in the company’s equity award program. 
 
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.  The Company offers a full range of medical, dental, and vision benefits.  Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.  The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.  As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. 
 
For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

We anticipate the application window for this opening will close on: 09/30/2024

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.