Director, Actuarial Services - Pharmacy / Part D

Director, Actuarial Services – Pharmacy / Part D

Pharmacy is one of the fastest-growing and most complex areas in healthcare, with annual spend at HAP exceeding $500M. Rising drug costs, new therapies, PBM contract shifts, and regulatory changes such as the Inflation Reduction Act are reshaping both risk and opportunity. Until now, HAP has relied heavily on external consulting support to meet urgent Part D and pharmacy analysis needs. This new Director role establishes dedicated, in-house pharmacy actuarial expertise to strengthen financial stability, accelerate insights, reduce consulting reliance, and proactively position HAP for competitive advantage in 2026 and beyond.

The Director, Actuarial Services – Pharmacy / Part D is responsible for leading all actuarial functions related to pharmacy benefits at Health Alliance Plan (HAP), with a primary focus on Medicare Part D and broader enterprise pharmacy strategy. This role provides actuarial leadership in pricing, forecasting, reserving, and bid development, while also serving as HAP's in-house expert on pharmacy financial optimization. The Director partners closely with HAP RX, CCS RX, Government Programs, Finance, and external stakeholders to ensure that HAP delivers value to members at a fair price, achieves financial stability across a $500M+ pharmacy spend, and positions itself competitively in a rapidly changing marketplace.

Principal Duties and Responsibilities

• Lead the development, submission, and validation of Medicare Part D bids, ensuring compliance with CMS requirements and incorporating the financial impact of the Inflation Reduction Act (IRA), MOOP changes, and other regulatory updates.
• Develop and maintain actuarial models to analyze pharmacy claims experience, utilization patterns, pipeline drugs, biosimilars, GLP-1 therapies, and emerging trends.
• Provide strategic actuarial expertise to evaluate and optimize formulary design, PBM contracting, rebate structures, 340B opportunities, and value-based pharmacy programs.
• Forecast pharmacy costs and revenue flows across all lines of business; identify and mitigate risks related to volatility in drug pricing, utilization, tariffs, and policy shifts.
• Collaborate with HAP RX, CCS RX, Government Programs, and Finance to design pharmacy cost management strategies that support affordability, member satisfaction, and long-term sustainability.
• Serve as a subject matter expert on pharmacy-related initiatives, ensuring actuarial analysis is fully integrated with work across other functions.
• Apply actuarial judgment and advanced analytics to evaluate the financial implications of legislative changes, regulatory reforms, and product strategies, and communicate these impacts across the organization.
• Anticipate and identify issues with material impact on pharmacy financial performance, using critical thinking to develop objective, actionable recommendations for resolution.
• Prepare executive-level presentations and recommendations for senior leadership and governance bodies.
• Reduce reliance on external consultants by building internal actuarial pharmacy expertise, resulting in more timely insights and cost-effective analysis.
• Mentor and develop actuarial team members, supporting exam progress and professional growth.

Education / Experience Required

• Bachelor's degree in actuarial science, mathematics, statistics, finance, or related field required.
• Associate of the Society of Actuaries (ASA) required; Fellow of the Society of Actuaries (FSA) preferred.
• Member of the American Academy of Actuaries (MAAA) preferred.
• Minimum of five (5) years of progressive actuarial experience with demonstrated expertise in Medicare Part D, pharmacy benefits, and bid development.
• Minimum of five (5) years of leadership/project management experience, preferably including responsibility in a matrixed environment.
• Strong knowledge of CMS Part D rules, IRA implications, risk corridors, DIR/rebates, reinsurance, and MOOP changes.
• Demonstrated success in building actuarial models and forecasting methodologies to evaluate pharmacy trends.
• Advanced proficiency in Excel and actuarial modeling tools; experience with SQL, SAS, R, or Python preferred.
• Healthcare payer experience required; Medicare Advantage / Part D strongly preferred.

Leadership Competencies

• Strategic thinker able to balance deep technical expertise with enterprise-wide impact.
• Collaborative and influential leader, able to work across actuarial, pharmacy, finance, and operations.
• Strong communication skills with ability to translate complex actuarial findings into actionable strategies.
• Committed to talent development, professional standards, and HAP's mission of delivering value and affordability to members.