Associate Actuary (Medicare Pharmacy Trend Analytics) - CarelonRx

About the role

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.

Responsibilities

• 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.
• 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.
• 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.

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.

Benefits

CarelonRx is a proud member of the Elevance Health family of companies. 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.

Pay

The pay range for this position is $80,000 - $120,000 annually, depending on experience and qualifications.

Schedule

The 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.

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.

Equal Employment Opportunity

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.