Actuarial Manager I – Medicaid | CVS Health


Job Description

This role is open to anywhere in the U.S.A.

This position will be part of the Medicaid Actuarial team’s involvement with Revenue Integrity, a crucial initiative for the Medicaid Business Unit, and will specifically provide Actuarial support and oversight for the encounter data submission process, a key element the underpins revenue integrity activities. Even though this role does not have any direct reports you will be able to mentor/coach others on certain projects.

This position’s responsibilities will include (but are not limited to):

  • Overseeing the reconciliation of Medicaid medical fee-for-service, pharmacy and sub-capitated vendor data within the dashboard to financial data.
  • Coordinating with local Medicaid finance teams to understand and track capitation withholds, quality payments, and encounter penalties as they relate to encounter data submission processes.
  • Establishing a partnership with the Medicaid Informatics team for Encounter Dashboard development ideation, with the goal of better opportunity prioritization within the dashboard.


Required Qualifications

5 to 8 years actuarial work experience.

Must be an ASA or FSA and a member of the American Academy of Actuaries able to sign state rate filings and other required actuarial certifications.

Preferred Qualifications

Good communication skills and problem solving skills are essential.

Experience in Medicaid, prior work on risk adjustment, and demonstrated experience with project management is preferred but not required.


A Bachelor’s degree is required.

Business Overview

At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.


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