Actuary - Medicare Part D - Evernorth

This position will provide external actuarial analytics support within the regulated Medicare market and Pharmacy Benefit Manager (PBM) Healthplan actuarial strategy role is designed to provide a designated full time support to Express-Scripts external clients Medicare Part D business. This role will matrix with internal leadership within trend formulary clinical knowledge solutions sales & account management and supply teams. The role will assist in development of actuarial analyses for Medicare Part D business including but not limited to; special CMS programs drug expense analyses and projections financial forecasts actuarial modeling pharmacy network optimization strategies manufacturer rebates optimization regulatory impact assessment and ad hoc actuarial analyses as needed.

The position requires an experienced strategic viewpoint in wide variety of actuarial prescription drug subjects within the enterprise industry and regulatory environments.

The Essential Responsibilities of the Role include:

Product Support / Development

• Co-lead development of Actuarial analytics products for Express Scripts existing Part D Plans

• Perform financial analyses of proposed regulatory changes demonstration programs and other special programs by CMS to determine financial impact on various entities within the drug supply chain

• Develop actuarial models to aid in prospective projections of Medicare Part D Plan clients plan liability and premium impact sensitivities

• Build actuarial models and project management functions to accelerate and safeguard improvements in the development of analytics tools to identify gaps in the Medicare Part D market

• Lead studies to aid in identification of gaps in the Medicare Part D Prescription Drug Health market to aid in development of strategies to help close identified gaps

Analytics Support to Part D Plans

• Drive strategic discussion to develop analytics road map to optimize Part-D revenue optimization and cost-reduction strategies for Medicare Part D Health Plans: PDP MAPD and Special Needs Program (SNPs)

• Review Medicare Part D Plan bid assumptions for Regulated Medicare Part D Health Plans

• Create analytics for Medicare Part D Bids substantiation for Desk Review and Medicare Part D audits

• Utilize independent judgement and discretion to perform complex customized actuarial analyses for Part D Health Plans

Cross-Functional Financial Support

• Collaborate with internal Express-Scripts business partners and external vendors to determine operation feasibility and financial ramifications of special programs

• Apply distinct Part D subject matter expertise (SME) to facilitate analytics capabilities measure performance and aid in problem solving and creation of actionable insights for technical teams within Express-Scripts enterprise

• Cross-functional collaboration within Express-Scripts enterprise Medicare Part D financial and operational strategy development. Examples include:

  • Advanced trend analytics

  • Medical Loss Ratio (MLR) / member profitability projections

  • Formulary Strategy

  • Clinical Analytics around prescription drugs pipeline products

  • Out of Pocket Cost

  • Member risk score analysis / benchmarking

  • Quantification of impact of regulatory proposals and changes

  • Regulated Part D Health Plan Financial Reconciliation Support

• Assimilate macro and micro trends develop benchmarks gather competitive intelligence to develop market competitive strategies

• Train and educate non-actuarial internal teams on Medicare Part D market financial and analytics components

Qualifications

• Bachelors degree in Actuarial Science Economics Statistics Finance or other quantitative field strongly preferred

• 5 years of actuarial experienceor 3 years of consulting experience

• ASA (or near ASA) strongly preferred; FSA preferred

• Part D Prescription Drug or Part D bid development consulting experience preferred

• Regulated Markets Medicare Part D Experience Pharmacy Benefit Manager (PBM) / Healthcare / pharmaceutical experience preferred; consulting experience strongly preferred

• Track record of managing multiple projects and teams that deliver client driven growth insightful actions

• Proven capabilities in modeling forecasting and predictive analytics

• Strong communication and presentation skills; written/ verbal proficiency

• Coding skills in either SQL R SAS or Python strongly preferred

• Preferred: Extensive understanding of US Prescription drug supply chain and Medicare knowledge with specific acumen in Part D including but not limited to:

  • Part D Bid Development Desk Review & Audits

  • CMS Regulatory Compliance / Reporting

  • Financial Reconciliation Modeling

  • Trend Analyses

  • Formulary Modeling Experience

  • Network Optimization Modeling

  • Rebates Modeling

  • Market Landscape analytics

  • Risk Score Modeling

• Ability to gather and analyze information execute a map and execute strategies designed to aid in growth of existing business and building of new businesses preferred

• Ability to structure ambiguous actuarial and financial analyses and synthesize and communicate complex analyses in simple and digestible data driven takeaways to internal and external senior leadership teams preferred

This role is also anticipated to be eligible to participate in an annual bonus plan.

We want you to be healthy balanced and feel secure. Thats why youll enjoy a comprehensive range of benefits with a focus on supporting your whole health. Starting on day one of your employment youll be offered several health-related benefits including medical vision dental and well-being and behavioral health programs. We also offer 401(k) with company match company paid life insurance tuition reimbursement a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs visit Life at Cigna Group.

About Evernorth Health Services