Director & Actuary, Pharmacy Trend and Health Value Optimization

🔍 Work From Home

New

📁: Actuarial

📅   : Oct 14, 2026 Post Date

📅   : 261243 Requisition #

Bring your drive for excellence, team orientation, and customer commitment to Independence. Help us renew and reimagine our business and shape the future of health care.

The Director & Actuary, Pharmacy Trend and Health Value Optimization leads the actuarial functions responsible for pharmacy trend forecasting, pharmacy cost analytics and Health Value Optimization (HVO) valuation. This role establishes the pharmacy cost outlook across Medicare, Commercial, ACA and Self-Funded business and turns pharmacy, clinical, formulary, contracting, and policy developments into actionable financial guidance. The Director also owns the profitability studies that support Large Group experience rating, ensuring pricing decisions reflect credible historical performance, emerging cost trends and expected financial results.

This role leads a team of actuaries and analysts and provides senior leaders with clear recommendations on pharmacy cost, affordability, pricing and investment decisions.

Responsibilities

Lead pharmacy trend and forecasting: Own pharmacy trend methodologies, assumptions, governance and short- and long-term forecasts across lines of business.
Identify emerging cost drivers: Evaluate specialty launches, pipeline therapies, biosimilars, generics, patent expirations, rebates, utilization changes and Medicare Part D policy developments.
Monitor financial performance: Explain actual-to-expected results, resolve material variances and update the pharmacy cost outlook as experience changes.
Lead HVO valuation: Set actuarial methods for evaluating affordability initiatives, developing business cases and measuring realized savings and return on investment for pharmacy-related initiatives.
Own Large Group pharmacy profitability studies: Direct the profitability studies used to support Large Group pharmacy experience rating, including methodology, assumptions, analysis of historical results and communication of pricing implications.
Support pricing and planning: Provide pharmacy assumptions and actuarial guidance for Medicare bids, Commercial and ACA pricing, Self-Funded underwriting, rate filings, budgets and long-range financial plans.
Advise on pharmacy strategy: Partner with Pharmacy Strategy and Contract Management on PBM economics, market checks, contracting scenarios, rebate strategy, formulary decisions and performance assessments.
Provide executive decision support: Translate pharmacy performance, risks and opportunities into concise recommendations for senior leadership.
Lead and develop the team: Set priorities and analytical standards, build scalable forecasting and value-measurement capabilities, and coach actuarial and analytical professionals.

Qualifications

Required Qualifications

Bachelor's degree in actuarial science, mathematics, statistics, economics, finance or a related field.
Fellow of the Society of Actuaries (FSA), or ASA with substantial relevant leadership experience.
Eight or more years of progressive health actuarial experience in pharmacy, medical cost, forecasting, pricing or financial analytics.
Experience leading actuaries or analysts and delivering work through cross-functional teams.
Strong understanding of health plan economics and the ability to connect detailed analysis to pricing, margin and strategic decisions.
Clear executive communication and demonstrated ability to influence decisions across organizational boundaries.

Preferred Qualifications

Pharmacy pricing, trend forecasting, Medicare Part D, PBM economics, rebates, specialty pharmacy, formulary strategy or value measurement.
Large Group experience rating, profitability analysis or pricing studies.
Drug- or class-level forecasting models and integration of results into pricing and planning processes.
Presentation of complex or financially significant issues to senior executives.

How Success Will Be Measured

Credible and timely pharmacy cost forecasts and trend recommendations.
Earlier identification of material cost risks and affordability opportunities.
Clear assessment of the expected and realized value of HVO initiatives.
Profitability studies that provide a sound basis for Large Group experience-rating decisions.
Consistent pharmacy assumptions across pricing, forecasting and financial planning.
A strong, scalable and well-developed pharmacy actuarial and analytics team.

This position is eligible to work remotely within the United States. Candidates must be able to work effectively in a virtual environment and maintain regular business-hour availability. Periodic travel may be required for team meetings, leadership sessions, training, and business needs.

Independence Blue Cross is an Equal Opportunity and Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.

Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.

Inclusion and Belonging

At IBX, everyone can feel valued, supported, and comfortable to be themselves, and all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. Celebrating and embracing diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.

About Our Company

Serving nearly 10 million people in 25 states and the District of Columbia, including 2.5 million in southeastern Pennsylvania, Independence Health Group is the leading health insurance company in the Philadelphia region, and we’re expanding across the country. Our mission to build healthier lives for you, your family, and your employees shapes our actions and decisions every day.

At Independence, we see each of our members as an individual, with unique needs and concerns. We’re dedicated to harnessing the very latest ideas and technologies to deliver access to care that meets those needs and surpasses your expectations. For more information about Independence access our website at www.ibx.com. We’re revolutionizing health care, and our focus is on you!

Equal Employment Opportunity

IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.

Agency Disclaimer

All resumes submitted directly to an Independence Blue Cross employee from a vendor via email, the Internet or in any other form without a valid written search agreement in place for this position from the Independence Blue Cross Family of Companies Human Resources Department will be deemed the sole property of Independence Blue Cross and the Independence Blue Cross Family of Companies. Please note that no fee will be paid in the event the candidate is hired by Independence Blue Cross or the Independence Blue Cross Family of Companies as a result of the referral or through means other than our established process.