Executive Director, Actuarial - Medicare Network

Job description

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary: Aetna is recruiting for an Executive Director, Actuarial to lead Medicare network insights and curation support for a critical line of business. This role is fully dedicated to Medicare and is responsible for helping shape, inform, and advance the broader Medicare network strategy, including network design to support distinct Medicare member needs. This leader will operate at the intersection of actuarial rigor, network strategy, and enterprise decision-making. The role requires the ability to translate complex and at times competing inputs into clear, credible recommendations that strengthen performance, support growth, and build alignment across senior stakeholders. Success in this role will depend not only on technical depth, but on the ability to gain consensus, influence direction, and secure buy-in across a highly matrixed environment. Key Responsibilities Lead Medicare network insight generation and curation support in service of membership and broader line-of-business goals Partner with senior business leaders to shape network strategy, inform key decisions, and support execution against Medicare growth and performance priorities Enable Network market leaders with actionable market-level performance insights, including provider performance analysis, curation strategy, data cubes, HCIC-based reporting, and related decision support Support and influence plan sponsor-specific RFP strategy through actuarial analysis, business judgment, and cross-functional partnership Identify the most critical business issues, synthesize root causes, and mobilize the right partners to drive solutions Translate multiple, and at times conflicting, data sources into clear, executive-level recommendations that balance risk, opportunity, and enterprise impact Build well-reasoned points of view grounded in logic, business acumen, and strategic context, while remaining adaptable as new information emerges Drive both divergent and convergent thinking by connecting ideas, challenging assumptions, and moving teams toward aligned, actionable paths forward Lead effectively through ambiguity, helping stakeholders navigate competing priorities and reach clear decisions Build trust and foster collaboration across actuarial, network, Medicare, and market teams to drive enterprise alignment Influence resources within and beyond direct reporting lines to deliver complex, cross-functional work at scale Develop and empower talent by creating an environment that encourages thoughtful challenge, idea-sharing, accountability, and strong execution Required Qualifications 10+ years of actuarial experience in health insurance Deep Medicare experience, including Bid Pricing, CMS reimbursement structures such as IPPS, OPPS, and Physician Fee Schedule, and broader CMS knowledge Approximately 5+ years of people leadership experience Broad experience across actuarial functions Demonstrated ability to operate effectively in a highly matrixed environment and influence across diverse stakeholder groups Strong execution and delivery skills, including planning, driving work forward, and supporting implementation Advanced Excel and SQL skills, including the ability to manipulate data and generate actionable insights Strong strategic and business judgment, including the ability to assess tradeoffs, evaluate risk, and recommend a logical course of action Executive presence and the ability to communicate complex insights clearly and credibly to senior internal and external stakeholders Preferred Qualifications Demonstrated ability to build consensus and secure senior-level buy-in on complex, high-impact decisions Executive-level influence and storytelling, with the ability to translate actuarial and network insights into clear, compelling narratives Strategic agility and comfort operating in ambiguity while maintaining focus on outcomes Strong cross-functional leadership and collaboration skills, with a track record of aligning diverse perspectives around a common path forward Innovative problem-solving capability, including curiosity, creativity, and the ability to connect disparate ideas into forward-looking solutions Experience helping shape new product, network, or financial model approaches Education: Bachelor’s degree or equivalent. ASA required FSA valued Pay Range The typical pay range for this role is: $175,100.00 - $334,750.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments . We anticipate the application window for this opening will close on: 08/28/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.