Actuary - Accountable Care

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
 
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

CVS Accountable Care is seeking a highly motivated and experienced actuary to join our fast-growing organization. The actuary will be a key person on the CVS Accountable Care team in supporting the business to meet financial objectives by identifying and quantifying opportunities and risks, through key root-cause analyses, and manage the risk position of various value-based products (Medicare Advantage, MSSP, ACO REACH).

What will you do?

• Evaluate the impact of Medicare quality and risk adjustment program has on our MA risk contracts and ACOs (MSSP and ACO REACH), including but not limited to risk adjustment opportunities, HCC gaps, and benchmarking analysis.
• Develop analytics strategies to drive performance for our partners and ACOs through the use of actuarial and advanced analytics techniques
• Proactively identify areas of opportunities for improvement and actionable insights for our partners and our ACOs using claims and real-time data.
• Build models to help CVS Accountable Care identify areas to improve utilization of healthcare services
• Develop the appropriate level of reserves and analyze claims completion patterns for our ACOs
• Conduct descriptive and predictive analyses to identify opportunities to target population health interventions, improve care delivery, contribute to product and services development, and inform CVS Accountable Care’s growth strategy
• Analyze various sources of patient care and claims data, including 100% Medicare data or VRDC, to provide actionable insights to stakeholders
• Get up to speed on our data model and make recommendations for changes to improve the accuracy and efficiency of the monthly claims completion process
• Proactively identify and communicate issues affecting a project plan
• Prepare comprehensive documented observations, analyses and interpretations of results including technical reports, summaries and quantitative analyses
• Present analysis results to internal and external audiences, including company executives, subject matter experts, delivery teams, and clinical teams within Signify Health/ CVS Accountable Care
• This is an individual contributor role

Required Qualifications

-Bachelor’s degree along with 3+ years of relevant work experience

-ASA or close to ASA required

-Strong knowledge of Medicare Advantage products, ACO, MSSP, ACO REACH

-High expertise in SQL,SAS, Python or R, with the ability to perform effective querying involving multiple tables & subqueries

-Deep expertise in working with large Medicare claims dataset

-Ability to conduct actuarial and risk adjustment (CMS-HCC) analysis

-Excellent oral & written communication skills; ability to present complex information to a non-technical audience

Preferred Qualifications
Master’s Degree or higher in Mathematics, Statistics, Actuarial Science or closely related field.

Experience w/Medicare Limited Data Set (5% Sample Data)

Prior Experience in Value-based care settings

Proficient in Excel, Work  PowerPoint

Education
Bachelor’s degree or Masters degree in related field

Pay Range

The typical pay range for this role is:

$60,300.00 - $145,860.00

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. 
 
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.  The Company offers a full range of medical, dental, and vision benefits.  Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.  The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.  As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.  
 
For more detailed information on available benefits, please visit Benefits | CVS Health

We anticipate the application window for this opening will close on: 12/27/2024

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.