Principal Actuary – Pharmacy Benefit Manager (PBM) Oversight
About The Position
As a Principal Actuary within our growing Pharmacy Analytics team, you will act as a key member of our enterprise's ability to shape the future of our pharmacy benefits. This highly visible role provides actuarial oversight of our Pharmacy Benefit Manager (PBM). You will be responsible for translating complex contractual requirements into actionable financial models, standing up new, innovative, and complex PBM arrangements, and driving value through rigorous analytics. You will work closely with internal pharmacy leadership and external partners to ensure the company remains competitively positioned in a dynamic marketplace.
Requirements
- Bachelor's degree or advanced degree (where required)
- Associate of the Society of Actuaries(ASA) and Member of the American Academy of Actuaries (MAAA)
- 5+ years of experience in related field
- In lieu of an ASA, alternate actuarial credentials may be considered.
- In lieu of 5 years of experience, may consider candidates who are Fellows of the Society of Actuaries (FSA).
Nice To Haves
- Experience with PBM contract negotiation, GPOs, 340b, Pharmacy Network Contracting, and/or Pharmacy Rebate Contracting – Highly Preferred
- Experience with Specialty Pharmacy modeling
- Excellent verbal and written communication skills, with the ability to explain complex financial/actuarial information to non-technical audiences and senior leadership. – Highly Preferred
- Proven ability to build relationships and work effectively with internal and external partners. – Highly Preferred
- Expert-level knowledge of SAS, SQL, and advanced Excel – Highly Preferred
- Experience building complex financial models.
- Exceptional analytical and creative problem-solving skills.
- Ability to work effectively in a team-based, collaborative environment.
- Self-motivated, resourceful, and able to work independently in a fast-paced, high-growth environment.
Responsibilities
- PBM Contract Modeling & Oversight: Translate complex PBM contractual terms into robust financial/actuarial models, ensuring all contractual requirements are met or exceeded.
- Strategic Initiatives: Lead the setup and implementation of new, complex PBM arrangements.
- Rebate & Financial Reconciliation: Perform detailed PBM rebate reconciliations, ensuring accuracy in financial forecasting and payment accuracy.
- Analytics & Forecasting: Develop and maintain sophisticated models to forecast rebates, analyze pharmacy cost trends, and identify opportunities for savings.
- Strategic Collaboration: Work with key stakeholders (Pharmacy Operations, Finance, Legal) to align pharmacy strategy with broader health plan goals.
- Industry Leadership: Monitor industry news, regulatory changes, and competitive landscape to maintain a competitive position.
- Mentorship: Indirectly manage and mentor less senior actuarial team members, fostering growth in pharmacy financial acumen.
Benefits
- The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community.
- Work-life balance, flexibility, and the autonomy to do great work.
- Medical, dental, and vision coverage along with numerous health and wellness programs.
- Parental leave and support plus adoption and surrogacy assistance.
- Career development programs and tuition reimbursement for continued education.
- 401k match including an annual company contribution
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What This Job Offers
Job Type
Full-time
Career Level
Principal
