Your Role
The Cost of Health Care Actuarial team is responsible for supporting the Pharmacy Reimagined strategy in addition to traditional actuarial functions of claim reserves and cost trends.
The Pharmacy Actuarial Analyst, Principal will report to the Senior Director, Cost of Health Care Actuarial. In this role you will support the Pharmacy Team’s strategic objectives in contract negotiations, formulary changes, product development, and initiative evaluation.
Your Work
In this role, you will :
- Understand the core principles and functionality underlying decision, descriptive, predictive, and prescriptive advanced analytic methods
- Conduct and develop analysis, assess risk and population risk scores and assignment, develop pricing and trends, assess changes in benefit designs, develop reserves, perform forecasting, analyze provider reimbursement terms and / or evaluates actuarial risk related analysis
- Coordinate, prepare, perform, and audit actuarial analyses to assist in the development of complex actuarial formulations leading to the recommendation of pricing, trending, reserving, provider reimbursement and / or risk assessment strategies
- Perform data exploration using a combination of statistical programming languages (including, but not limited R, Python, SQL, SAS) and deploys predictive analytics and machine learning techniques to improve risk prediction, improve reserve, trend and financial forecasting in a manner that is actuarially sound, and enable real-time results and operational efficiencies
- Lead, coordinate and / or develop strategic, market and competitive analysis
- Support vendor financial contract performance evaluation, forecast and negotiation ( rebates, network contracts)
- Support development of budget / trend impact models and formulary strategy models for high impact existing and pipeline drugs
- Provide actuarial Rx data support and participate in product governance / value assessment committee on Rx benefit and formulary strategy
- Support ASO product strategy evaluation and coordinate with UW and trendsetter actuary as needed
- Support RxCare strategic initiatives evaluation as needed
Actuarial Analyst, Principal
The Pharmacy Actuarial Analyst, Principal will report to the Senior Director, Cost of Health Care Actuarial. The Cost of Health Care Actuarial team is responsible for supporting the Pharmacy Reimagined strategy in addition to traditional actuarial functions of claim reserves and cost trends. Coordin...
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