Aetna Sr. Director - Actuarial; Medicare and/or Medicaid Pharm in Blue Bell, Pennsylvania

Req ID: 45638BR


Aetna Medicare & Medicaid pharmacy business is growing. We are looking for experiences, high-performing actuaries with pharmacy experience in Medicare Part D, Medicaid, and/or PBM activities (formulary strategy, pharmacy network, clinical management programs, etc.) to join our team.

Fundamental Components:

Leadership: Management of Resources- Sponsor, develop and lead projects to support strategic and operating plans. Influence/motivate resources within and outside of direct control to complete projects. Exhibit innovative use of resources. Scope of Decision Making- Broad decision making authority that may cross multiple disciplines, functions, regions or segments. Staffing/Personnel- Influence the development of a high performing management team through more strategic oriented human capital planning. Ensure access to appropriate tools, resources and training. Aetna Way- Foster behavior that reflects Aetna s values and is in accordance with the Aetna Way.Product & Business Knowledge: Assumptions & Data Sources- Review assumptions developed by staff from a business perspective and be able to influence senior management to accept alternative recommendations. Integrate understanding of internal and external data sources for quantifying risks. Programs, Policies & Processes- Apply knowledge of corporate products, programs, processes and policies to resolve cross-functional and cross-enterprise problems and issues. Regulatory Issues- Assure compliance with applicable regulations, laws and standards.Risk Analysis & Management: Risk Assessment- Provide leadership in the negotiation and influencing of sound business decisions through adherence to established risk management principles. Rate Filing- Facilitate regulatory process. Respond to internal and external auditors. Validate and/or sign certifications of compliance. Reserve Analysis- Review reserve recommendations and set adequate reserve levels. Planning & Forecasting- Review recommendations and set forecast in collaboration with finance and business partners. Pricing, Trend & Benefit Design- Partner with business owners in decision making process around pricing and trend. Technical Proficiency: Use of Technology- Develop creative technical solutions to a variety of problems. Stay apprised of technical innovations as potential solutions for actuarial issues and concerns. Development & Implementation- Oversee/manage the development and implementation of tools and models. Maintenance & Enhancements- Manage cost to implement and prioritize changes to processes, tools and systems. Approve funding. Business Specifications- Signoff on detailed business requirements for system development. Testing- Review testing results for changes to processes, tools and systems.Communication, Collaboration & Consultation: Constituent Focus- Lead interdepartmental teams to shape process and policy. Represent Aetna on industry workgroups/SOA or Academy forums. Verbal & Written Communication- Address most complex business issues. Have direct interaction with internal and external constituents. Maintain accurate documentation and consult on training and user support for tools and processes. Interaction with Constituents- Promote and influence collaborationThe role can be configured around the expertise and experience of the right candidate. If you are a high-performing actuary with pharmacy experience in Medicare Part D, Medicaid, and/or PBM activities (formulary strategy, pharmacy network, clinical management programs, etc.) we want to hear from you!


10+ years pharmacy experience.


The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.


Actuarial/Fellow of the Society of Actuaries is strongly preferred

Actuarial/Associate of the Society of Actuaries is required


Functional - Actuarial/Management: < 25 employees/7-10 Years

Functional - Actuarial/Modeling & tool development/More Than 10 Years

Functional - Actuarial/Financial actuarial analysis/More Than 10 Years

Functional - Actuarial/Rating system development & support/4-6 Years

Functional - Actuarial/Risk analysis/management/More Than 10 Years


TechnicalExperience/TechnicalFocus/More Than 10 Years/Power User


Finance/Delivering Profit and Performance/MASTERY

Finance/Managing Aetnas Risk/MASTERY

General Business/Communicating for Impact/MASTERY


Leadership/Collaborating for Results/MASTERY

Leadership/Creating Accountability/MASTERY

Leadership/Developing and Executing Strategy/MASTERY

Telework Specifications:

Flexible telework and/or office-based schedule (any office location)


Government business is the growth engine at Aetna. This role offers executive level exposure and career growth for the right candidate.

Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

Job Function: Actuarial