Director Pharmacy Pricing Strategy - Actuarial

Director Pharmacy Pricing Strategy - Actuarial at RxBenefits, Inc.

RxBenefits is hiring! We are adding an Actuarial Director to our growing Pricing Team, reporting to the Senior Director, Pricing Strategy! The Director Pharmacy Pricing Strategy - Actuarial is a key contributor to the success of growing RxBenefits. The role is responsible for strategy execution and operational direction of actuarial efforts within our Commercial Pharmacy line of business. The Director Pharmacy Pricing Strategy - Actuarial will lead a team who drives the development of models, pricing strategies, and risk assessments to support organizational objectives and influence key business decisions.

Essential Job Responsibilities Include:

• Directs and provides leadership support for our 360 and IlluminateRx lines of business by setting and guiding actuarial initiatives.
• Ensures compliance with regulatory requirements and actuarial standards.
• Assesses and manages financial risk, including recommendations for mitigation and alternative financial solutions.
• Develops pricing for new benefits, models financial impacts of alternative rating arrangements, and contributes to the corporate financial plan and multi-year forecast.
• Designs and prepares actuarial reports for clients, brokers, and internal stakeholders.
• Development of trend assumptions (Utilization, Cost, Pipeline, Seasonality, etc).
• Participates in audit activities, as assigned.
• Responsible for hiring and maintaining actuarial staff, which includes interviewing and selection of personnel, completing performance reviews, counseling staff, and other administrative matters.
• Develops professional staff by identifying and coordinating training needs for actuarial program.
• Provide actuarial support for pharmacy initiatives, RFPs, broker/client relations, program ROI, and acquisition targets.
• Collaborate effectively with cross functional stakeholders, including senior leadership, PBMs, actuaries, brokers, and other vendors.
• Deliver actionable insights that improve financial performance and forecasting capabilities.
• Participate in strategic and cross-functional meetings, ensuring alignment on business goals and operational efficiencies.
• Oversee and prioritize workload distribution, ensuring optimal resource allocation and timely project execution.
• Create, update, and standardize Standard Operating Procedures (SOPs) to ensure clarity and compliance across teams.
• Create, maintain, and lead training initiatives including conducting training sessions, introducing new hires to job responsibilities, company policies, and procedures.
• Organize, refresh, and enhance training materials to support ongoing employee development and knowledge retention.
• Own and manage template updates including pricing, formulary, legal, product, and formulary changes while also identifying opportunities to streamline and improve template design and functionality to enhance efficiency.
• Perform accuracy reviews and additional support functions for the leadership team on RxBenefits Pricing updates across all partner PBMs.
• Generate and deliver ad hoc reports across various business topics providing timely and accurate data insights to support decision-making processes and to drive organizational improvements across departments.

Required Skills / Experience:

• Bachelor's degree in actuarial science, Mathematics, Statistics or another related field.
• 7+ Years Actuarial experience in a pharmacy / managed care setting.
• 5+ years supervisory or managerial experience.
• Fellow of the Society of Actuaries (FSA) and Member of the Academy of Actuaries (MAAA).
• Extensive knowledge of Commercial Pharmacy insurance products, operations, and existing regulations.
• Awareness of legal, political, economic, and environmental impacts on the Commercial Pharmacy insurance product and operation.
• Organizational skills.
• Good judgment.
• Ability to persuade, negotiate or influence.
• Strong verbal and written communication skills including presentation skills.
• Advanced Knowledge of Microsoft Office.
• Advanced Computer programming skills / languages (SAS, SQL, etc).
• Ability to explain technical subjects to a non-technical audience.

Key skills/competency

• Actuarial Science
• Pharmacy Pricing
• Risk Assessment
• SAS Programming
• SQL
• Managed Care
• Regulatory Compliance
• Leadership Development
• Financial Forecasting
• Commercial Pharmacy