Lead Director, Medicare Actuarial Analytics and Actuarial Data Science

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Position Summary
We are seeking a strategic and technically proficient leader to oversee Medicare data science initiatives supporting actuarial analytics and pricing. The ideal candidate will have deep expertise in CMS Part C and D programs, Medicare Advantage bid cycle management, and pricing strategies. This role requires a strong understanding of regulatory frameworks, actuarial modeling, and healthcare economics. The candidate needs to be able to lead cross-functional teams and drive innovation in Medicare analytics.
While hands-on experience in data science and machine learning is not required, familiarity with these areas is considered a plus. The successful candidate will lead a growing team focused on enhancing pricing accuracy, optimizing bid strategies, and supporting Medicare operations through advanced analytics and actuarial insights.
Key Responsibilities:

• Lead the development and execution of actuarial analytics strategies for Medicare Advantage and Part D programs.
• Inform and enhance the end-to-end bid cycle process, including pricing, forecasting, and regulatory compliance.
• Serve as a subject matter expert on CMS regulations, risk adjustment, and revenue optimization.
• Collaborate with internal stakeholders to identify opportunities for improving Medicare pricing and operational efficiency.
• Translate complex actuarial and regulatory requirements into actionable business strategies.
• Mentor and guide a team of data scientists, fostering a culture of innovation and continuous improvement.
• Partner with data science teams to explore and integrate advanced analytics techniques where applicable.
• Represent the actuarial analytics function in discussions with senior leadership and external stakeholders.

Required Qualifications

• 8+ years Actuarial Experience, preferably in the Healthcare Industry.
• 5+ years of experience in Medicare Advantage actuarial pricing, bid development, and CMS Part C/D operations.
• 5+ years' experience working with CMS regulations, risk adjustment methodologies, and revenue management.
• 5+ years' experience leading actuarial teams and managing complex projects with measurable business impact.
• 5+ years' experience demonstrating strong communication skills with the ability to convey technical concepts to non-technical audiences.
• 5+ years' experience with actuarial modeling tools and data platforms (e.g., SAS, SQL, Python, Excel).
• FSA or ASA designation.

Preferred Qualifications

• Familiarity with data science and machine learning concepts, particularly in healthcare applications.
• Experience collaborating with data science teams or integrating predictive analytics into actuarial workflows.
• Strong project management skills and experience working in agile environments.

Education

• Bachelor's degree in actuarial science, Mathematics, Statistics, or a related field required.
• Master's degree preferred.

Pay Range
The typical pay range for this role is:
$144,200.00 - $288,400.00
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company's equity award program.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan .
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit anticipate the application window for this opening will close on: 07/14/2025
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. #J-18808-Ljbffr