Translate complex PBM contractual terms into robust financial/actuarial models, ensuring all contractual requirements are met or exceeded.
Lead the setup and implementation of new, complex PBM arrangements.
Perform detailed PBM rebate reconciliations, ensuring accuracy in financial forecasting and payment accuracy.
Develop and maintain sophisticated models to forecast rebates, analyze pharmacy cost trends, and identify opportunities for savings.
Work with key stakeholders (Pharmacy Operations, Finance, Legal) to align pharmacy strategy with broader health plan goals.
Monitor industry news, regulatory changes, and competitive landscape to maintain a competitive position.
Indirectly manage and mentor less senior actuarial team members, fostering growth in pharmacy financial acumen.

Requirements

Bachelor's degree or advanced degree (where required)
Associate of the Society of Actuaries(ASA) and Member of the American Academy of Actuaries (MAAA)
5+ years of experience in related field
In lieu of an ASA, alternate actuarial credentials may be considered.
In lieu of 5 years of experience, may consider candidates who are Fellows of the Society of Actuaries (FSA).
Experience with PBM contract negotiation, GPOs, 340b, Pharmacy Network Contracting, and/or Pharmacy Rebate Contracting – Highly Preferred
Experience with Specialty Pharmacy modeling
Excellent verbal and written communication skills, with the ability to explain complex financial/actuarial information to non-technical audiences and senior leadership.
Proven ability to build relationships and work effectively with internal and external partners. – Highly Preferred
Expert-level knowledge of SAS, SQL, and advanced Excel – Highly Preferred
Experience building complex financial models.
Exceptional analytical and creative problem-solving skills.
Ability to work effectively in a team-based, collaborative environment.
Self-motivated, resourceful, and able to work independently in a fast-paced, high-growth environment.

Benefits

Medical, dental, and vision coverage along with numerous health and wellness programs.
Parental leave and support plus adoption and surrogacy assistance.
Career development programs and tuition reimbursement for continued education.
401k match including an annual company contribution.

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

financial modelingactuarial modelingrebate reconciliationpharmacy cost analysisPBM contract negotiationSpecialty Pharmacy modelingSASSQLadvanced Excelanalytical problem-solving

Soft Skills

verbal communicationwritten communicationrelationship buildingteam collaborationself-motivationresourcefulnessindependencementoringleadershipcreative problem-solving

Certifications

Bachelor's degreeadvanced degreeAssociate of the Society of Actuaries (ASA)Member of the American Academy of Actuaries (MAAA)Fellow of the Society of Actuaries (FSA)