Managing Consulting Actuary
A leading actuarial and healthcare consulting firm is seeking a Senior Consulting Actuary to support Medicare Part D and Medicare Advantage clients across pricing, bid development, forecasting, and regulatory strategy. This individual will serve as a key advisor to health plans, helping clients navigate the evolving Medicare landscape while developing competitive and financially sound Part D pricing strategies.
The ideal candidate will possess deep expertise in Medicare Part D bid development, pricing methodologies, CMS regulations, forecasting, and financial modeling. This role offers significant client exposure and the opportunity to influence strategic decision-making for some of the nation's leading health plans.
- Lead Medicare Part D and MAPD bid development projects for health plan clients.
- Develop and review key bid assumptions including trend, formulary, membership, risk scores, rebates, low-income subsidy impacts, and benefit changes.
- Perform pricing analyses, financial forecasting, and profitability assessments to support bidding strategies.
- Advise clients on Medicare regulatory changes, CMS guidance, Inflation Reduction Act impacts, and emerging market trends.
- Support bid desk reviews, CMS audit requests, and annual bid submission processes.
- Conduct competitive market analyses and recommend strategies to improve pricing performance and member value.
- Partner with pharmacy, clinical, finance, product, and underwriting teams to develop integrated pricing solutions.
- Build and enhance actuarial models used for Medicare pricing, forecasting, and scenario testing.
- Present findings and strategic recommendations to client executives and senior stakeholders.
- Mentor junior consultants and provide technical oversight on actuarial deliverables.
- Contribute to business development initiatives and cultivate long-term client relationships.
Qualifications
- ASA or FSA designation; MAAA preferred.
- 5+ years of actuarial experience with a focus on Medicare Advantage and/or Medicare Part D.
- Direct experience supporting Medicare Part D bid development and pricing.
- Strong understanding of CMS bid requirements, formulary design, risk adjustment, rebates, and Medicare regulations.
- Experience working with Medicare bid assumptions, forecasting models, and financial projections.
- Proven ability to communicate complex actuarial concepts to non-technical stakeholders.
- Advanced Excel skills required; experience with SQL, SAS, Python, R, or actuarial modeling tools preferred.
- Prior consulting experience or significant client-facing experience is highly desirable.
Preferred Experience
- Medicare Part D bid strategy and pricing optimization.
- CMS bid audits, desk reviews, and regulatory compliance.
- MAPD/PDP product development and benefit design.
- Pharmacy trend analysis, rebate forecasting, and formulary evaluations.
- Financial forecasting, budgeting, and long-range strategic planning.
- Leadership of actuarial projects and mentoring of junior staff.
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