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Principal Actuary – Pharmacy Benefit Manager Oversight

IT SupportIT SupportOtherRemoteLeadTeam 501-1,000Since 1997H1B No SponsorCompany SiteLinkedIn

Location

Kentucky + 4 moreAll locations: Kentucky | Louisiana | North Carolina | Mississippi | South Carolina

Posted

105 days ago

Salary

$118.7K - $189.9K / year

Seniority

Lead

Bachelor Degree5 yrs expExperience acceptedEnglishSQL

Job Description

Principal Actuary – Pharmacy Benefit Manager Oversight

E-Verify Program

• Translate complex PBM contractual terms into robust financial/actuarial models, ensuring all contractual requirements are met or exceeded. • Lead the setup and implementation of new, complex PBM arrangements. • Perform detailed PBM rebate reconciliations, ensuring accuracy in financial forecasting and payment accuracy. • Develop and maintain sophisticated models to forecast rebates, analyze pharmacy cost trends, and identify opportunities for savings. • Work with key stakeholders (Pharmacy Operations, Finance, Legal) to align pharmacy strategy with broader health plan goals. • Monitor industry news, regulatory changes, and competitive landscape to maintain a competitive position. • Indirectly manage and mentor less senior actuarial team members, fostering growth in pharmacy financial acumen.

Job Requirements

  • Bachelor's degree or advanced degree (where required)
  • Associate of the Society of Actuaries(ASA) and Member of the American Academy of Actuaries (MAAA)
  • 5+ years of experience in related field
  • In lieu of an ASA, alternate actuarial credentials may be considered.
  • In lieu of 5 years of experience, may consider candidates who are Fellows of the Society of Actuaries (FSA).
  • Experience with PBM contract negotiation, GPOs, 340b, Pharmacy Network Contracting, and/or Pharmacy Rebate Contracting – Highly Preferred
  • Experience with Specialty Pharmacy modeling
  • Expert-level knowledge of SAS, SQL, and advanced Excel – Highly Preferred
  • Experience building complex financial models.

Benefits

  • Medical, dental, and vision coverage along with numerous health and wellness programs.
  • Parental leave and support plus adoption and surrogacy assistance.
  • Career development programs and tuition reimbursement for continued education.
  • 401k match including an annual company contribution
  • Work-life balance, flexibility, and the autonomy to do great work.

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