Actuarial Principal, EGWP Pricing & Strategy - Express Scripts - Remote

The Cigna Group • Bloomfield, CT

8h • Remote

About The Position

The Actuarial Principal, EGWP Pricing & Strategy is a senior actuarial leader responsible for the end-to-end pricing strategy, financial modeling, and proposal development for fully insured Employer Group Waiver Plans (EGWPs). This role blends deep Medicare Part D/EGWP technical expertise with executive-level influence to drive profitable growth, enterprise value creation, and client retention/expansion. The Actuarial Principal leads the design of pricing proposals that balance market competitiveness and client-specific growth objectives with sustainable margins, risk controls, and long-term portfolio performance.
This role is intended to support our largest EGWP Third Party Administrator (TPA) by driving pricing strategies and analytics that help retain and grow mutual clients fully insured Medicare Part D business.
This individual partners across Sales, Account Management, Underwriting, Finance, Product, Supply Chain, and Legal—translating complex actuarial insights into clear, actionable recommendations for internal leadership and external clients. The role will also include actuarial analyses for Medicare Part D business, including but not limited to: special CMS programs, drug expense analyses and projections, financial forecasts, actuarial modeling, pharmacy network optimization strategies, manufacturer rebates optimization, regulatory impact assessment, and ad hoc actuarial analyses as needed.

Requirements

• Associate of the Society of Actuaries (ASA) or Fellow of the Society of Actuaries (FSA) designation (FSA preferred).
• Bachelor’s degree in Actuarial Science, Mathematics, Statistics, Economics, or related field (or equivalent experience).
• 10+ years plus of actuarial experience in health insurance, with direct EGWP and/or Medicare pricing experience.
• May be required to travel periodically (for internal and external meetings)
• Strong technical skills in Excel, Access and actuarial modeling software.
• Demonstrated experience leading pricing strategy for complex accounts and influencing senior stakeholders.
• Strong expertise in pricing methodologies, trend development, credibility, and experience analysis.
• Proven ability to balance enterprise profitability objectives with market/client growth needs.
• Advanced analytical and modeling skills (Excel required; SAS/R/Python/SQL a plus).
• Exceptional communication skills—able to present to executives and negotiate with sophisticated client stakeholders.
• Demonstrate sound business judgment when drawing conclusions and making recommendations.
• Proven capabilities in modeling, forecasting, and predictive analytics.
• Extensive understanding of US Prescription drug supply chain and Medicare knowledge, with specific acumen in Part D, including but not limited to:
• Part D Bid Development, Desk Review & Audits
• CMS Regulatory Compliance / Reporting
• Financial Reconciliation Modeling
• Trend Analyses
• Formulary Modeling Experience
• Network Optimization Modeling
• Rebates Modeling
• Market Landscape analytics
• Risk Score Modeling

Nice To Haves

• 5+ years plus prior experience with Pharmacy Benefit Management (PBM).
• Deep understanding of Medicare PDP market specific to EGWP plans.
• Experience with group retiree solutions, risk adjustment concepts, and employer segment dynamics.
• Familiarity with network contracting economics, PBM/pharmacy pricing, and benefit design levers.
• Prior experience developing standardized pricing frameworks and governance models across multiple markets or employer segments.
• Track record of leading through ambiguity and shaping strategy in evolving regulatory/market environments.
• Comfortable working in a fast-paced matrixed environment, balancing constant change/demands with efficient practices to maximize productivity.

Responsibilities

• EGWP Pricing Leadership & Proposal Development
• Own the pricing strategy, rate development and risk management for the Medicare Part D Fully Insured Employer Group Waiver Plan across new sales and renewals.
• Lead the creation and review of client pricing proposals, ensuring they are actuarially sound, compliant, and aligned with enterprise financial goals (margin, revenue, capital, risk appetite) and client growth goals (competitiveness, participation, retention).
• Collaborate with executive leadership to align actuarial insights with business goals. Present issues, opportunities and recommended solutions/strategies to leadership to better inform key decisions.
• Develop scenario-based pricing options (e.g., buy-downs, benefit changes, network levers, plan design alternatives), articulating trade-offs in profitability vs. growth.
• Enterprise Value Optimization
• Drive portfolio-level financial performance through pricing discipline, risk management, and forward-looking assumption governance.
• Evaluate and recommend strategies that improve long-term enterprise value, including margin durability, volatility reduction, and scalable pricing processes.
• Partner with Finance and Regulated Markets leadership on annual planning, experience monitoring, and performance attribution (e.g., identifying drivers of favorable/unfavorable results).
• Client Growth Enablement & Market Competitiveness
• Serve as a strategic partner to Sales and Account teams—helping craft winning proposals without compromising long-term economics.
• Provide market insights on competitive positioning, pricing approaches, and evolving EGWP dynamics to inform go-to-market strategy.
• Assimilate macro and micro trends, develop benchmarks, gather competitive intelligence to develop market competitive strategies.
• Participate in (or lead) external client meetings to explain pricing, answer questions, and negotiate terms with credibility and clarity.
• Cross-Functional Influence & Collaboration
• Collaborate with external Third Party Administer (TPA) directly and in conjunction with Sales & Account Management and Regulated Markets on competitive pricing bids for Employer Group clients that align with overall retention and growth strategies.
• Provide actuarial input into overall product strategy, competitive positioning, taking into account the market dynamics and client/broker/TPA feedback.
• Translate complex actuarial findings into executive-ready narratives, including key drivers, risk considerations, and recommended actions.
• Perform financial analyses of proposed regulatory changes, demonstration programs, and other special programs by CMS to determine financial impact on various entities within the drug supply chain.
• Cross-functional collaboration within Express-Scripts/enterprise Medicare Part D financial and operational strategy development. Examples include:
• Advanced trend analytics
• Medical Loss Ratio (MLR) / member profitability projections
• Formulary Strategy
• Out of Pocket Cost
• Member risk score analysis / benchmarking
• Quantification of impact of regulatory proposals and changes
• Regulated Part D Health Plan Financial Reconciliation Support
• Data Analysis, Governance & Modeling:
• Oversee development and refinement of actuarial models.
• Analyze large datasets to inform pricing, forecasting, and financial reporting.
• Ensure models and outputs align to internal policies, regulatory guidance, actuarial standards of practice, and appropriate controls.
• Oversee data integrity checks, experience studies, and assumption updates tied to emerging experience.
• Provide necessary pricing information for audit purposes or supplemental enhanced benefit regulatory requirements/filings.
• Develop and maintain actuarial models to aid in prospective projections of Medicare Part D Plan client’s plan liability and premium impact sensitivities.
• Drive continuous improvement in pricing tools, automation, and analytical approaches.

Benefits

• Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs.
• We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior