Actuary

• Conducts analysis, pricing and risk assessment to estimate financial outcomes.
• Applies knowledge of mathematics, probability, statistics, principles of finance and business to calculations in health with a focus on dental plans.
• Develops probability tables based on analysis of statistical data and other pertinent information.
• Gaining exposure to some of the complex tasks within the job function.
• Occasionally assists with modeling, identifies appropriate data sources, conducts analysis

Actuarial Analyst

• Provide actuarial leadership and oversight for DCS pricing activities, including rate reviews, underwriting, and annual pricing submissions.
• Establish and maintain actuarial standards, pricing frameworks, and governance processes.
• Review, approve, and recommend rate actions, pricing assumptions, and risk positions.
• Own actuarial evaluation of margin performance and profitability drivers.
• Ensure pricing strategies and rate execution are aligned with target margins and durable growth goals.
• Identify emerging risks and develop mitigation strategies in partnership with Business Leads, Finance and Underwriting.
• Assess and manage the financial and pricing implications of federal and state regulatory changes impacting Commercial Pharmacy and Mental Health Parity.
• Oversee intercompany pharmacy pricing discussions and work with both Caremark and Aetna IBU teams to ensure pharmacy value is effectively deployed for Fully Insured, AFA and integrated ASC business.
• Lead and mentor a multi-disciplinary team, fostering organizational agility and development.

AVP, Commercial Specialty Actuarial & Underwriting

• Demonstrate commitment to career development and growing financial acumen by pursuing actuarial credentials and membership in the Society of Actuaries
• Prepare and analyze intermediate level data for use in actuarial experience studies, valuation or pricing projects
• Assist in maintenance of pricing and underwriting tools and provide support for helping others understand underwriting case specific issues by answering technical questions
• Develop reserve factors
• Develop experience analysis reviews
• Assist in maintaining valuation system
• Assist in preparation of financial reports, tax returns and state filings as needed
• Learn current pricing models and risk management practices
• Contribute to product development and re-pricing initiatives
• Communicate research results to manager both in written format and orally
• Prepare routine reports
• Continuous assessment of established training and work processes to identify areas for effectiveness and efficiency improvements.
• Contribute to operating effectiveness through information sharing, suggested process improvements and effective implementation of change
• Communicate trends and issues identified and proactively recommend resolutions to management
• Work on special projects that require actuarial research and analysis which may involve partnering with other business areas both in and out of finance.
• Continuously build a specialized working knowledge of the company operations, systems and in the actuarial discipline
• May perform other duties as assigned

Actuarial Assistant, Actuarial Development Program

• Design and maintain actuarial models to forecast healthcare utilization across the payer landscape (Medicare, Medicaid, Commercial, etc.)
• Analyze historical and emerging trends in healthcare delivery, utilization, and cost drivers
• Quantify and communicate drivers of variance to financial plans by specialty and payers
• Project revenue as a function of healthcare utilization, integrating actuarial standards and external trend information
• Inform quarterly and annual financial forecasts with actuarially sound inputs
• Evaluate the impact of legislative, regulatory, and market changes on revenue and utilization
• Conduct studies to identify early signs of adverse trends or opportunities for improvement
• Present findings and actionable recommendations to executive leadership and cross-functional teams
• Lead actuarial analysis of market trends, competitor strategies, and payer landscape changes
• Build, improve, and document models used for financial forecasting
• Enhance predictive analytics and proprietary algorithms to optimize outcomes
• Collaborate with market leadership, clinical operations, IT, and finance teams to align analytics with business needs

Manager, Actuarial Analytics

• Work in a fast-paced, innovative, and change-oriented work environment
• Build a strong network of peers and mentors
• Attend on-site technical and professional development classes
• Participate in sponsored community service events
• Utilize advanced Excel techniques and programming
• Work with large data sets
• Gain exposure to actuarial software, including GGY AXIS, MG-ALFA, and PolySystems

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