Senior Actuary - Network

CVS Health•Hartford, CT

21h

About The Position

This position within the network analytics team provides the financial tools and analytics to support network strategy in alignment with market/business growth priorities. The market-specific responsibilities will provide individuals with the opportunity to develop in-depth knowledge of market dynamics and to establish strong cross-functional relationships with key business partners, including network, MEU, and commercial actuarial teams. Additional core areas of focus include network discounts, emerging trend analytics, and pricing and contracting support.

Requirements

Bachelors degree along with 5+ years of actuarial and/or analytical experience with strong technical, analytical, and financial skills.
ASA designation.

Nice To Haves

Excellent written and verbal communication skills.
Programming (SQL, SAS, Python, R) 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

Develop a quarterly, market-level discount review process to inform Regional Leads and Chief Network Officers of changes in benchmarking based on the latest view, identifying gaps and pressured areas to consider for future negotiations.
Provide meaningful information to the field on the impact and expected timing of new negotiations beyond current consultant benchmarking.
Engage cross-functionally with Network, MEU, and other teams to drive enhanced contract negotiation strategies using data-driven recommendations for MedRx and Behavioral Health.
Provide support for Aetna Whole Health / APCN Plus (Performance Networks), joint ventures, and narrow network pricing across all Commercial market segments.
Validate and refine pricing using contracting insights such as trend, PCRs, and area factors during Large Group Rate Review.
Build a suite of tools and analyses to provide optimal strategic support for Priority Markets and Strategic/Enhanced Providers.
Address a complex and error-prone mix of state-specific standard contracts by selecting a single, competitive fee schedule that is consistent across state lines.