Director & Actuary, RX Underwriting

About the Role

Lead the actuarial, underwriting, financial forecasting, pharmacy benefit management (PBM) oversight, and client performance functions that support the organization's pharmacy business. Responsible for strategic financial analysis, pharmacy trend forecasting, pricing strategy, vendor and PBM financial oversight, client guarantee management, forecasting, regulatory compliance, and cross-functional business partnership. Serve as the primary actuarial advisor to pharmacy leadership and key enterprise stakeholders while ensuring delivery of critical operational, financial, and client-facing commitments.

Responsibilities

• Pharmacy Financial Forecasting & Actuarial Leadership
  • Leads pharmacy cost forecasting, reforecasts, annual operating plan development, and monthly financial projections.
  • Analyzes pharmacy utilization and trend drivers to support medical expense forecasting and enterprise financial planning.
  • Develops actuarial analyses supporting pricing, product development, benefit design, and strategic initiatives.
  • Communicates emerging trends, risks, and opportunities to executive leadership and business partners.
• Pharmacy Pricing & Underwriting
  • Oversees pharmacy underwriting strategy for renewals, new business opportunities, RFPs, and market competitiveness assessments.
  • Directs pricing studies, margin analyses, guarantee evaluations, and pharmacy product financial modeling.
  • Supports ACA, Medicare Part D, and commercial pharmacy pricing initiatives.
  • Evaluates market trends and competitive positioning to maintain profitable and competitive pharmacy offerings.
• PBM Oversight & Vendor Management
  • Provides financial oversight of PBM contracts, performance guarantees, rebate programs, and discount arrangements.
  • Leads financial evaluations during PBM procurements, vendor negotiations, and contract renewals.
  • Oversees reconciliation activities, invoice validation, rebate accruals, and guarantee compliance.
  • Assesses vendor performance and recommends strategies to optimize value and mitigate financial risk.
• Client Financial Management & Guarantee Administration
  • Oversees client rebate settlements, discount guarantee settlements, accruals, and reserve calculations.
  • Leads client audit support, financial reporting, and custom analytical evaluations.
  • Ensures timely and accurate client payments, contract compliance, and issue resolution.
  • Supports sales and account management teams with pricing analyses and client-facing financial consultations.
• Regulatory Compliance & Controls
  • Ensures compliance with financial controls, audit requirements, and Model Audit Rule (MAR) processes.
  • Maintains effective governance over key financial review and approval processes.
  • Supports internal and external audits and ensures operational controls are executed effectively.
  • Identifies and mitigates financial, operational, and compliance risks impacting pharmacy programs.
• Strategic Leadership & Business Partnership
  • Partners closely with Finance, Accounting, Clinical, Product, Pharmacy Services, Sales, Reserving, Pricing, and Executive Leadership teams.
  • Leads pharmacy financial strategy discussions and supports enterprise initiatives impacting pharmacy cost and revenue performance.
  • Influences organizational planning, resource prioritization, and long-term pharmacy business strategies.
  • Serves as a trusted advisor on pharmacy economics, pricing methodologies, and financial performance.
• Team Leadership
  • Provides leadership and direction to actuarial, underwriting, forecasting, and pharmacy financial analysis associates.
  • Establishes priorities, delegates work, develops talent, and ensures continuity of critical business functions.
  • Drives process improvement, operational efficiency, and knowledge transfer across the team.

Qualifications

• Education & Experience
  • Bachelor's degree in Mathematics, Statistics, Economics, or Actuarial Science
  • Fellowship in the Society of Actuaries
  • Prior supervisory experience required
  • 10+ years of healthcare industry experience to include actuarial, underwriting and pharmacy analytics experience
  • 6+ years of Pharmacy Actuarial experience preferred to include understanding the PBM Financial landscape
• Knowledge & Skills
  • Strong analytical, financial, and strategic planning skills.
  • Demonstrated ability to lead teams and collaborate across multiple business areas.
  • Excellent communication and stakeholder management capabilities.
  • Strong knowledge of rebates, guarantees, PBM contracting, healthcare finance, and regulatory requirements.
  • Demonstrated ability to lead cross-functional initiatives and influence executive-level decision making.
  • Advanced analytical, financial modeling, and stakeholder management skills.

Schedule

Hybrid model: Associates work in the office 3 days a week (Tuesday, Wednesday & Thursday) and remotely 2 days a week (Monday & Friday). Remote work must be performed in the Tri-State Area of Delaware, New Jersey, or Pennsylvania.