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This position will provide external and internal actuarial analytics support within the regulated Medicare market and Pharmacy Benefit Manager (PBM) Healthplan space. This role will matrix with trend, formulary, clinical, knowledge solutions, sales account management, and supply teams internally. 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.
Essential Responsibilities of the Role:
Product Support / Development

Assist in development of actuarial analytics products for Express Scripts existing and new Regulated Health Medicare Part D Plans
Perform studies to aid in the identification of gaps in the Regulated Prescription Drug Health market and develop strategies to help close identified gaps
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 and maintain actuarial models to aid in prospective projections of Regulated Health Plan clients plan liability and premium impact sensitivities
Build analytics Minimum Viable Product (MVP) products and project management functions, and facilitate effective pilot analytics improvement processes to accelerate and safeguard improvements development of analytics tool to identify gaps in the regulated Medicare Part D market

Analytics Support to Existing Medicare Part D Plans

Assist in reviewing Medicare Part D Plan bid assumptions for Regulated Medicare Part D Health Plans
Assist in analytics development 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 business partners and external vendors to determine operation feasibility and financial ramifications of special programs
Cross-functional collaboration within 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 modeling)
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

Qualifications

Bachelors degree in Actuarial Science, Economics, Statistics, Finance or other quantitative field strongly preferred
4+ years of actuarial experience
Medicare Part D experience strongly preferred
Pharmacy Benefit Manager (PBM), healthcare or pharmaceutical experience preferred
Understanding of fundamental US Prescription drug supply chain and Medicare knowledge preferred
ASA (or near ASA) strongly preferred but not required
Proven capabilities in modeling, forecasting, and predictive analytics
Strong written and verbal communication and presentation skills
Ability to gather and analyze information to aid in growth of existing business and building of new businesses
Coding skills in either SQL or SAS required, Python / R preferred
This role can require up to 15% of travel.

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
For this position, we anticipate offering an annual salary of 97,400 - 162,400 USD / yearly, depending on relevant factors, including experience and geographic location.
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
Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you require reasonable accommodation in completing the online application process, please email: [email protected] for support. Do not email [email protected] for an update on your application or to provide your resume as you will not receive a response.
The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

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