Hartford, Connecticut

Job Description
The National Medical Cost Analytics team in the Medical Economics Unit is seeking an actuarial professional with the primary role leading the Aetna HCB Commercial Individual Exchange Medical Expense Review. This is an exciting opportunity to leverage medical cost analytics expertise to serve as a SME at the forefront of Aetna/CVS Health’s reemergence on the Individual Exchange in 2022 and beyond. The role will further act as a liaison to the individual market business leads and stakeholders in actuarial, product, network, finance, etc. to provide actionable insight in response to medical cost drivers through use of business acumen. The candidate will work in a fast-paced, dynamic, and rapidly changing environment and gain exposure to many different areas of the company through collaboration and communication of results.

• Perform complex medical and financial cost analysis to evaluate real time medical cost drivers and develop strategic options and opportunities to favorable impact medical cost in support of a new line of business

• Identify key stakeholders across Finance, Actuarial, and Market Leadership to foster successful collaboration in support of broader enterprise strategy

• Leverage strong communication skills and influence to lead development of new reporting, exhibits, and Medical Expense Review meeting content and share work product and findings with business stakeholders as part of the quarterly MER meeting cycle

• Demonstrates knowledge of economic, demographic, regulatory, and other individual marketplace drivers including the on/off exchange environment, metallic levels, geographies, demographics, and subsidies as well as the overall competitive environment

• Support implementation and creation of enterprise initiatives to respond to medical cost pressures and mitigate unfavorable drivers of segment performance

• Apply technology to improve business processes and compliance (SQL, Python, SAS, VBA, R, and full suite of Microsoft Office products) and actively participate in the change management process related to emerging technologies and data, specifically the successful launch and adoption of new ADAM (Aetna Date of Service Analytic Model) Cloud platform and inclusion of Individual data

• Determine the financial impact resulting from changes CVS Health and Aetna’s medical cost management strategy, pricing position and earnings generation; provide support related to medical cost actions and medical cost strategy with decision making on pricing and long term, sustainable earnings growth.

• Interface with senior leadership, describing detailed and intricate data in a way that can be digested by VPs and above. The role combines a dense subject matter expertise with proficient communication skills.

Pay Range
The typical pay range for this role is:
Minimum: 75,400
Maximum: 158,300

Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.

Required Qualifications
5 or more years of complex medical and financial cost analysis in a managed care setting

COVID Requirements

COVID-19 Vaccination Requirement
CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.

You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.

Preferred Qualifications
• Individual exchange and competitive environment as well as governing regulation
• Key managed care functions including provider contracting, benefit design, medical management as well as knowledge of business functions and impact on financials (underwriting, sales, product development, network management)
• Individual exchange and competitive environment as well as governing regulation
• Manage conflicting priorities and multiple projects concurrently. Demonstrates initiative, innovation and leadership in achieving results
• Demonstrates critical thinking and expresses ideas clearly, concisely, and logically from a cross functional perspective
• Leading change, developing new content to inform and influence senior business leads and relevant stakeholders
• Expertise in analytical and problem-solving skills
• Strong organizational, management and leadership skills
• Excellent written and verbal communication and presentation skills.

Bachelor’s Degree or equivalent work experience required

Business Overview
Bring your heart to CVS Health
Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day.
CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. See Job Description

Hartford, Connecticut

Continue serving and work with a purpose

As a CVS Health colleague, you'll find career opportunities across the organization and at every stage of your career. More important, your work will have an impactful purpose on someone's life, including your own. Learn more about how you can continue serving on your next mission at CVS Health.

Careers for Veterans and Military Spouses


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