VP, Actuarial -PBM

CVS Health in Boston, MA

  • Industry: Accounting - Others
  • Type: Full Time
position filled
**Job Description** The position has a wide latitude in developing and applying advanced consulting analysis for CVS Caremark and CVS Caremark clients. This individual will support strategic analysis with advanced actuarial analysis when necessary, help in setting overall strategic direction for Client Financial Analytics & Proposals departments and implement advanced analytic research findings, (implementation of findings may involve prototyping tools internally prior to rolling out on a production basis.) In addition, this position will identify, implement and train CVS Caremark employees in best practice strategies across market and region segments, participate in identifying risk for the Corporation, and help manage the Actuarial Department. Responsible for External Client Actuarial Consulting (over 12M Medicare Part D Lives). Responsible for responding to various risk guarantees for the PBM. Responsible for Corporate Trend Forecasts used by internal and external clients. Responsible for updating PBM U/W Pricing Tool Parameters. This role will lead client discussions that are highly complex financially. This role requires deep understanding of pricing/financial levers of our business and our client's businesses. A successful candidate for this role must have a demonstrated ability to understand the health plan business models. Specifically, the incumbent must have experience working with health plans that offer multiple lines of business, such as fully-insured, ASO, Medicaid, Medicare Part-D, and health insurance exchanges. The incumbent must also have experience influencing various types of health plan decision makers, including representatives from medical, pharmacy, actuarial, sales, and finance. This role will interact with key stakeholders at the client to negotiate the pricing, to upsell solutions, and to effectively achieve the client's goal for cost control and healthy outcomes. This position will maintain expert knowledge of the health insurance industry, PBM industry, current/emerging medical and pharmacy trend management strategies, current/emerging CVS Caremark enterprise offerings, CVS Caremark data warehouse, drivers of CVS Caremark enterprise revenue/profitability, and drivers of health plan client revenue/profitability. The successful candidate will have a proven track record of building and leading high-performing teams of knowledge-based employees with the necessary business acumen, clinical knowledge and technical skills to contribute to the goals of the business unit. The successful candidate will also have a track record that demonstrates the following abilities: developing and executing strategic business plans, working successfully in a cross-matrix environment, adapting and performing in a dynamic and changing environment, developing and leveraging a comprehensive understanding of CVS Caremark's enterprise assets, developing a deep understanding of internal and external goals, maintaining high levels of customer satisfaction, and applying clinical and analytical expertise to make informed recommendations and decisions **Required Qualifications** • At least 10 years of professional work experience that includes experience in the health care industry • Advanced Actuarial Skills in the Health Care Industry including Actuarial Standards of Practice (ASOPs). • Advanced Knowledge of CMS, Statutory, Pricing and Underwriting of Health Care required. • Advanced MS Office skills, advanced knowledge of relational databases and warehouses, advanced SQL, OLAP and SAS skills. • Strong problem solving, management skills, leadership skills. • Ability to manage, mentor, and motivate a team of highly skilled technical professionals. • Excellent writing and communication skills. Ability to work well in a multidisciplinary team environment, as well as independently. • Experience working with health plans, including payers with multiple lines of business with different funding arrangements. • Proven track record of implementing efficiency/solution developed primarily from input from end users, which successfully satisfy the business need. • Demonstrated experience in managing complex work processes in a cross-department, team environment. • Demonstrated success and experience in motivating individuals in a complete, fast-paced, high-pressure environment. • Demonstrated experience working successfully with Sales and Account Services. • Experience working in a geographically diverse company and in a matrix reporting environment **Preferred Qualifications** • Advanced degree **Education** • Bachelor's Degree (Finance, Business, Actuarial Science or Mathematics) **Business Overview** **It's a new day in health care.** Combining CVS Health and Aetna was a transformative moment for our company and our industry, establishing CVS Health as the nation's premier health innovation company. Through our health services, insurance plans and community pharmacists, we're pioneering a bold new approach to total health. As a CVS Health colleague, you'll be at the center of it all. We offer a diverse work experience that empowers colleagues for career success. In addition to skill and experience, we also seek to attract and retain colleagues whose beliefs and behaviors are in alignment with our core values of collaboration, innovation, caring, integrity and accountability. CVS Health is an equal opportunity/affirmative action employer. Gender/Ethnicity/Disability/Protected Veteran - we highly value and are committed to all forms of diversity in the workplace. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities. We comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW at https://www.dol.gov/ofccp/regs/compliance/posters/pdf/eeopost.pdf and EEO IS THE LAW SUPPLEMENT at https://www.dol.gov/ofccp/regs/compliance/posters/ofccpost.htm . We provide reasonable accommodations to qualified individuals with disabilities. If you require assistance to apply for this job, please contact our Advice and Counsel Reasonable Accommodations team at mailto:AdviceCounsel@cvshealth.com . Please note that we only accept applications for employment via this site. If technical issues are preventing you from applying to a position, contact Kenexa Helpdesk at 1-855-338-5609 or cvshealthsupport@us.ibm.com . For technical issues with the Virtual Job Tryout assessment, contact the Shaker Help Desk at 1-877-987-5352. </script>

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