PBM Actuarial Director
Position Summary
We are seeking an Actuarial Director with deep expertise in pharmacy economics, financial forecasting, and healthcare analytics to lead strategic pharmacy initiatives. This individual will serve as a key leader supporting pharmacy pricing, trend analysis, forecasting, and value optimization efforts. The ideal candidate will possess extensive experience working within a PBM environment or partnering closely with PBMs, along with a strong understanding of drug pricing dynamics, pharmacy benefit design, and overall healthcare economics.
Key Responsibilities
- Lead actuarial and financial analyses related to pharmacy benefit performance, drug trend management, and cost containment strategies.
- Develop and oversee pharmacy forecasting, pricing, reserving, and budgeting activities.
- Analyze pharmacy utilization, specialty drug trends, rebate programs, and formulary impacts to identify opportunities for improved financial performance.
- Partner with clinical pharmacy, finance, underwriting, product, and executive leadership teams to drive strategic decision-making.
- Evaluate PBM contract performance, pricing arrangements, and financial outcomes.
- Provide insights and recommendations regarding formulary strategies, specialty pharmacy management, and emerging pharmaceutical trends.
- Support Medicare, Medicaid, Commercial, and Value-Based Care pharmacy initiatives as applicable.
- Lead the development of advanced analytics, financial models, and reporting to monitor pharmacy performance.
- Present findings and recommendations to senior leadership and external stakeholders.
- Mentor and develop actuarial and analytics team members while helping establish best practices across the organization.
Qualifications
- Bachelor's degree in Actuarial Science, Mathematics, Statistics, Economics, or a related quantitative field.
- ASA or FSA designation required; FSA preferred.
- 8+ years of actuarial experience with significant pharmacy-focused responsibilities.
- Deep understanding of pharmacy economics, drug trends, specialty pharmacy, rebates, and benefit design.
- Direct experience working for a Pharmacy Benefit Manager (PBM) or extensive experience partnering with PBMs.
- Experience developing pharmacy pricing, forecasting, and financial models.
- Strong analytical and problem-solving skills with the ability to translate complex findings into business recommendations.
- Advanced proficiency in SQL and data analysis tools.
- Experience with Power BI, Tableau, SAS, Python, or other healthcare analytics tools preferred.
Preferred Experience
- Medicare Part D experience.
- Medicaid and Commercial pharmacy pricing experience.
- Experience supporting formulary strategy and rebate optimization initiatives.
- Knowledge of specialty pharmacy, biosimilars, and emerging pharmaceutical market trends.
- Experience leading actuarial or healthcare analytics teams.
FAQs
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