Associate Actuary (Medicare Pharmacy Trend Analytics) - CarelonRx

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Job Description:

Associate Actuary (Medicare Pharmacy Trend Analytics) - CarelonRx

Hybrid: This role requires associates to be in-office 1-2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law.

CarelonRx is a proud member of the Elevance Health family of companies. CarelonRx pairs a strong, clinical-first lens with deep pharmacy expertise to create solutions that improve outcomes, control costs, and enhance each member’s health.

The Associate Actuary (Medicare Pharmacy Trend Analytics) - CarelonRx completes the most diverse and complex projects and performs highly complex actuarial studies to evaluate and explain Medicare Part B and Part D pharmacy financial performance.

This role serves as the subject matter expert for Medicare pharmacy spend and trend performance, providing insights that directly influence pricing strategy, product design, financial forecasting, and executive decision-making.

How you will make an impact:

• Prepares and presents Medicare Part D and Part B drug spend and trend analyses for Medicare Individual and Group (GRS) businesses, communicating key cost drivers, product mix, member demographics, population shifts, and seasonality to support business decisions.
• Delivers actionable pharmacy spend and trend insights through recurring trend reporting, cohort studies, benefit phase analyses, and ad hoc analyses to identify emerging trends and assess Medicare pharmacy financial performance.
• Performs key actuarial functions including new product pricing, evaluation of the impact of new legislation, flexible benefit consulting, and special projects.
• Designs and completes special projects such as developing and maintaining experience-rating formulae and creating and/or reviewing alternative settlement formulae and risk-sharing models.
• Responsible for recommendations on pricing, marketing, product design, claims, premium, and enrollment administration of the business unit.
• Responsible for valuation support for the business unit by interpreting financial results and variances from forecast to identify product and segment behavior and assist in the risk management of the business unit.

Minimum Requirements:

• Requires a BA/BS degree and a minimum of 4 years of related experience; or any combination of education and experience that would provide an equivalent background.
• Associate of the Society of Actuaries (ASA) designation required.

Preferred Skills, Capabilities and Experiences:

• Previous Pharmacy Benefit Management (PBM) experience strongly preferred.
• Medicare Part D experience strongly preferred.
• Experience analyzing Medicare Part B drug spend and trend.
• Strong presentation and communication skills with the ability to explain complex Medicare Part B and Part D pharmacy spend and trend drivers to executive and health plan leadership.
• Experience interpreting pharmacy financial performance and communicating actionable insights to business stakeholders.
• Experience performing pharmacy spend and trend analyses, cohort studies, benefit phase analyses, and retrospective trend reporting.
• Experience evaluating the financial impact of CMS programs and Medicare legislation, including the Inflation Reduction Act (IRA).
• Experience with Databricks, SQL, Python, Snowflake, and Power BI.
• Experience working with large healthcare claims datasets and developing analytical reporting and visualization solutions.

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Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.

NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13, the posting will automatically come down on 3/12 at 11:59:59 PM. In other words — the job is posted until 3/13, not through 3/13.