Executive Director, Actuarial - Medicare Network

CVS Health•Hartford, CT

4d•Hybrid

About The Position

Aetna is recruiting for an Executive Director, Actuarial who will be responsible for understanding and driving action on Medicare Network Insights and curating support for this important line of business. This is an entirely Medicare focused role surrounding delivering on our overarching Medicare network strategy; it is inclusive of target network development in new geographies, and development of networks to support unique Medicare member needs. You will make an impact by: Achieving profitability and membership goals with business partners by contributing to strategies and executing them. Enabling Network Market leaders to drive Network Performance analysis at a market level– data cubes, HCIC (health care information center), curation of a network, and overall provider performance. Participating in state specific RFP conversations. Identifying core issues and leveraging colleagues/network to solve them. Navigating several data points, possibly contradictory, and rationalizes recommended course of action, recognizing risks and opportunities. Works with different areas to understand those data points. Recommends logical actions based on data and business acumen that weighs the pros and cons of calculated risks. Forming own opinions based in logic and business sense and having the flexibility to adjust as new ideas are presented, ie. shows a great balance of confidence, open-mindedness, and modesty. Ability for divergent thinking for brainstorming and connecting many ideas and ability for convergent thinking to ensure a recommended course of action and execution. When ideas do not work, have the perseverance to move forward and inspire their team to adjust. Building and facilitating a team environment of trust to foster collaboration and teamwork. Develops and empowers sharing ideas across the organization. Influencing resources within and outside of direct control to complete projects.

Requirements

10+ years actuarial health insurance experience.
Experience with Medicare Bid Pricing, Fee Schedule (IPPS/OPPS/Physician), and over all CMS knowledge
Approximately 5+ years of people management experience.
Broad experience with all actuarial functions.
Adept at execution and delivery (planning, delivering, and supporting) skills.
Experience working in a highly matrixed environment.
Advanced Excel application design skills, with ability to pull/manipulate data using SQL
Ability to conceptualize new product services and new financial models.
Possess an Executive Presence to present to internal and external customers.
Mastery of growth mindset (agility and developing yourself and others) skills.
Bachelor’s degree or equivalent.
ASA required

Nice To Haves

IRA knowledge would be valued
FSA valued

Responsibilities

Achieving profitability and membership goals with business partners by contributing to strategies and executing them.
Enabling Network Market leaders to drive Network Performance analysis at a market level– data cubes, HCIC (health care information center), curation of a network, and overall provider performance.
Participating in state specific RFP conversations.
Identifying core issues and leveraging colleagues/network to solve them.
Navigating several data points, possibly contradictory, and rationalizes recommended course of action, recognizing risks and opportunities.
Works with different areas to understand those data points.
Recommends logical actions based on data and business acumen that weighs the pros and cons of calculated risks.
Forming own opinions based in logic and business sense and having the flexibility to adjust as new ideas are presented, ie. shows a great balance of confidence, open-mindedness, and modesty.
Ability for divergent thinking for brainstorming and connecting many ideas and ability for convergent thinking to ensure a recommended course of action and execution.
When ideas do not work, have the perseverance to move forward and inspire their team to adjust.
Building and facilitating a team environment of trust to foster collaboration and teamwork.
Develops and empowers sharing ideas across the organization.
Influencing resources within and outside of direct control to complete projects.