Senior Manager, Actuarial

CVS Health•Woonsocket, FL

About The Position

CVS Health is seeking an experienced actuarial professional to support Medicaid managed care pricing evaluation, financial performance management, and strategic decision-making. The role combines actuarial expertise, business acumen, technical proficiency, and leadership. The Senior Manager will partner with market leadership, finance, and operational stakeholders, while providing guidance and oversight to actuarial analysts supporting complex Medicaid markets. The position calls for strong project management skills and the ability to balance short-term deliverables and ad hoc requests with long-term strategic initiatives, work effectively in a dynamic environment, and independently develop analyses for emerging business questions. The role leads actuarial evaluation of state capitation pricing and forecasting, interprets rate-setting methodologies and regulatory requirements, assesses business and financial drivers, and communicates findings to leadership. It also supports strategic decisions, monitors performance and trends, provides technical oversight of analytical work, mentors team members, coordinates stakeholders and resources, and develops or improves analytical methods and processes.

Requirements

Bachelor's degree required.
At least 5 years of actuarial experience in or adjacent to managed care or health insurance.
ASA designation required.
Strong SQL proficiency.
Strong Microsoft Excel proficiency.
Experience working with large healthcare datasets.
Knowledge of actuarial modeling and forecasting techniques.

Nice To Haves

Experience with actuarial pricing, forecasting, reserving, or financial planning functions.
Experience with healthcare data warehouses and reporting platforms.
Experience assessing and explaining drivers of financial performance.
Strong analytical and problem-solving skills, including the ability to manage ambiguity and new or complex business questions.
Ability to independently manage multiple priorities and competing deadlines.
Experience with data visualization tools such as Power BI.
Ability to generate new ideas, think strategically, and creatively solve problems that are not well defined.
Excellent written and verbal communication skills.

Responsibilities

Lead actuarial evaluation of state capitation pricing and forecasting for Medicaid managed care programs.
Evaluate and interpret state rate-setting methodologies, risk adjustment programs, acuity adjustments, and regulatory requirements.
Assess revenue, medical cost, utilization, and margin drivers to identify emerging trends and business risks.
Summarize and communicate actuarial analysis for business leadership.
Partner with market, product, finance, and operations teams to support strategic decision-making.
Provide insight into Medicaid market dynamics, state policy changes, competitive positioning, and business performance.
Evaluate the financial impacts of operational and strategic initiatives.
Support development of long-term business strategies through data-driven analysis.
Analyze medical cost trends, utilization patterns, enrollment changes, and financial performance.
Investigate emerging issues and perform root-cause analyses to explain variances from expectations.
Deliver concise and compelling insights to senior leadership.
Review, challenge, and understand analytical methodologies, models, and coding solutions developed by actuarial and analytics teams.
Provide technical oversight and direction to team members working with large healthcare datasets.
Collaborate with analysts and data professionals using SQL and other analytical tools.
Ensure analytical work is validated, documented, and reproducible.
Provide indirect leadership and mentorship for actuarial team members.
Coordinate work across stakeholders and analytical resources.
Foster accountability, collaboration, and trust with business partners.
Drive project completion by managing follow-ups, resolving obstacles, and ensuring commitments are met.
Design, build, document, and communicate new analyses to answer evolving business questions.
Identify opportunities to improve methodologies, reporting, and analytical processes.
Develop scalable solutions to support increasingly complex business needs.