Associate Actuary (Medicare Pharmacy Trend Analytics) - CarelonRx
About The Position
The Associate Actuary (Medicare Pharmacy Trend Analytics) - CarelonRx completes the most diverse and complex projects and performs highly complex actuarial studies to evaluate and explain Medicare Part B and Part D pharmacy financial performance. This role serves as the subject matter expert for Medicare pharmacy spend and trend performance, providing insights that directly influence pricing strategy, product design, financial forecasting, and executive decision-making. CarelonRx pairs a strong, clinical-first lens with deep pharmacy expertise to create solutions that improve outcomes, control costs, and enhance each member’s health.
Requirements
- Requires a BA/BS degree and a minimum of 4 years of related experience; or any combination of education and experience that would provide an equivalent background.
- Associate of the Society of Actuaries (ASA) designation required.
Nice To Haves
- Previous Pharmacy Benefit Management (PBM) experience strongly preferred.
- Medicare Part D experience strongly preferred.
- Experience analyzing Medicare Part B drug spend and trend.
- Strong presentation and communication skills with the ability to explain complex Medicare Part B and Part D pharmacy spend and trend drivers to executive and health plan leadership.
- Experience interpreting pharmacy financial performance and communicating actionable insights to business stakeholders.
- Experience performing pharmacy spend and trend analyses, cohort studies, benefit phase analyses, and retrospective trend reporting.
- Experience evaluating the financial impact of CMS programs and Medicare legislation, including the Inflation Reduction Act (IRA).
- Experience with Databricks, SQL, Python, Snowflake, and Power BI.
- Experience working with large healthcare claims datasets and developing analytical reporting and visualization solutions.
Responsibilities
- Prepares and presents Medicare Part D and Part B drug spend and trend analyses for Medicare Individual and Group (GRS) businesses, communicating key cost drivers, product mix, member demographics, population shifts, and seasonality to support business decisions.
- Delivers actionable pharmacy spend and trend insights through recurring trend reporting, cohort studies, benefit phase analyses, and ad hoc analyses to identify emerging trends and assess Medicare pharmacy financial performance.
- Performs key actuarial functions including new product pricing, evaluation of the impact of new legislation, flexible benefit consulting, and special projects.
- Designs and completes special projects such as developing and maintaining experience-rating formulae and creating and/or reviewing alternative settlement formulae and risk-sharing models.
- Responsible for recommendations on pricing, marketing, product design, claims, premium, and enrollment administration of the business unit.
- Responsible for valuation support for the business unit by interpreting financial results and variances from forecast to identify product and segment behavior and assist in the risk management of the business unit.
Benefits
- merit increases
- paid holidays
- Paid Time Off
- incentive bonus programs
- medical
- dental
- vision
- short and long term disability benefits
- 401(k) +match
- stock purchase plan
- life insurance
- wellness programs
- financial education resources
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
