Manager, Actuarial (ADP)

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

• 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. Strategic Business Support

• 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. Technical 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.

Innovation & Process Improvement

• 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.

Required Qualifications
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.

The typical pay range for this role is:

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. 
 

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.