Actuary - Network; Value Based Care

CVS Health • Atlanta, GA

10d

About The Position

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. Position Summary This position in Network Actuarial will support our relationships with our VBC (Value Based Care) partners, by setting and evaluating cost targets to determine the success of the VBC arrangements. This position will involve exposure to many different areas of Aetna’s commercial business while working on the cutting edge of provider relationships. The candidate must be willing to work in a fast paced, dynamic, and rapidly changing environment. This position will support the VBC strategy in the following areas: Work closely with Medical Economics consultants in the creation and review of financial reconciliations for provider partners; contribute to the development and design of new tools to support the entire process. Involvement in ad hoc work related to the ongoing evolution of the VBC business model, including researching potential methodology changes, development and creation of new tools, and development of marketing materials. Maintain relationship with Milliman in support of claims trends to support Self-insured reconciliations, including managing financial relationship with Milliman in support of our contract. As an expert on value-based reconciliations, you will be responsible for developing and implementing actuarial and underwriting policies and procedures and providing case specific guidance/support. The ideal candidate will possess excellent written and verbal communication skills and provide superior customer service to both internal and external constituents. Working in a matrixed environment across multiple functions, the ideal candidate must thrive in a constantly evolving setting with competing priorities and deadlines. Problem solving skills are critical as many of the concepts are continually developing and evolving. The ideal candidate must be flexible, and able to effectively balance competing priorities as they will be looked to as a key member of the team assisting and supervising work across a variety of Value Based Care models.

Requirements

• Bachelor's degree along with 3+ years of actuarial and/or analytical experience
• ASA or FSA required
• Prior healthcare experience
• Value-based contracting experience is highly desired
• Strong technical, analytical, and financial skills
• Experience in or appetite to learn SQL language.

Nice To Haves

• Excellent written and verbal communication skills
• Programming (SQL, Python, GCP, Coginiti) experience
• Provide superior customer service to both internal and external constituents.
• Thrive in a constantly evolving environment with competing priorities and deadlines.
• Problem solving skills are critical as many of the concepts are new or in development.
• Ability to generate new ideas, think strategically, and creatively solve problems that are not well defined.

Responsibilities

• Work closely with Medical Economics consultants in the creation and review of financial reconciliations for provider partners; contribute to the development and design of new tools to support the entire process.
• Involvement in ad hoc work related to the ongoing evolution of the VBC business model, including researching potential methodology changes, development and creation of new tools, and development of marketing materials.
• Maintain relationship with Milliman in support of claims trends to support Self-insured reconciliations, including managing financial relationship with Milliman in support of our contract.
• As an expert on value-based reconciliations, you will be responsible for developing and implementing actuarial and underwriting policies and procedures and providing case specific guidance/support.

Benefits

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees