Principal Actuary (PBM)
Job Title: Senior Manager, Actuary (PBM)
Company: Confidential - Leading Consulting Firm
Location: Multiple Locations
Department: Health Practice
About the Company:
A leading global management consulting firm is seeking a Senior Manager, Actuary (PBM) to join its growing Health practice. The firm is known for delivering impact through deep industry knowledge and cutting-edge analytical insights. Its Health practice partners with a wide range of healthcare organizations - including health insurers, pharmacy benefit managers (PBMs), pharmaceutical companies, and healthcare providers - to drive innovation, reduce costs, and improve patient outcomes.
The Health practice has a strong presence in the healthcare industry, with deep expertise in health insurance, pharmacy benefits, value-based care, and healthcare delivery models. Its collaborative and data-driven approach allows it to deliver strategic and operational improvements, helping clients navigate the rapidly evolving healthcare landscape.
The consulting team is made up of actuaries, data scientists, healthcare strategists, and industry experts who work together to solve complex challenges. The firm values creativity, analytical rigor, and client impact, empowering its consultants to develop innovative and practical solutions.
Role Overview:
The firm is seeking a highly skilled Senior Manager, Actuary (PBM) to join its Health practice. In this role, the successful candidate will leverage deep expertise in pharmacy benefits and actuarial analysis to advise clients on PBM strategy, drug pricing, formulary design, and contract optimization. The Senior Manager will lead project teams, manage client relationships, and develop innovative solutions to address complex challenges in the PBM space.
This is a unique opportunity to join a high-impact team within a leading consulting firm, working on cutting-edge solutions that shape the future of pharmacy benefit management and healthcare financing. The Senior Manager will work closely with partners and clients, guiding strategic decisions and helping to transform how healthcare organizations manage drug costs and pharmacy benefits.
Key Responsibilities:
Lead and deliver complex consulting projects focused on PBM strategy, pricing, and financial performance.
Analyze pharmacy claims data, rebate structures, and formulary performance to develop strategic insights for clients.
Develop financial models to assess the impact of PBM contract terms, drug pricing strategies, and utilization trends.
Guide clients in optimizing PBM partnerships, including contract negotiation and value-based pricing models.
Provide actuarial support for health plan formulary design, drug cost containment, and benefit design strategies.
Collaborate with the firm's health actuarial, data science, and healthcare strategy teams to integrate pharmacy insights into broader healthcare models.
Lead the design and execution of market entry strategies, business model development, and operational improvements for PBM-related offerings.
Develop pricing and cost containment strategies for specialty drugs and high-cost therapies.
Manage and mentor junior actuarial staff, providing technical guidance and professional development.
Present findings and strategic recommendations to senior-level client stakeholders and executive teams.
Contribute to business development, including identifying opportunities, developing proposals, and expanding client relationships.
Stay current on industry trends, regulatory changes, and market developments in the PBM and pharmacy benefits space.
Required Qualifications:
Bachelor's degree in Actuarial Science, Mathematics, Statistics, or a related field.
Fellow of the Society of Actuaries (FSA)
7+ years of actuarial experience in the healthcare or PBM industry.
- Deep understanding of PBM contract structures, drug pricing mechanisms, and rebate strategies.
Strong experience with pharmacy claims data analysis and predictive modeling.
Proven ability to lead project teams and manage client relationships.
Excellent analytical, communication, and presentation skills.
Strong proficiency in actuarial modeling tools and data analysis platforms (e.g., Excel, SAS, R, Python).
Demonstrated ability to work in a fast-paced, collaborative, and results-driven environment.
Experience developing and executing complex financial models related to pharmacy benefits.
Preferred Qualifications:
Experience with PBM contract negotiation and value-based pricing strategies.
Familiarity with Medicare Part D, Medicaid, and Commercial pharmacy benefits.
Experience with specialty drug pricing and trend forecasting.
Background in consulting or client-facing roles within the healthcare industry.
Experience in designing and implementing cost containment strategies for high-cost therapies.
Knowledge of pharmacy benefit risk management and stop-loss strategies.
FAQs
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