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The Actuarial Principal, EGWP Pricing & Strategy is a senior actuarial leader responsible for the end-to-end pricing strategy, financial modeling, and proposal development for fully insured Employer Group Waiver Plans (EGWPs). This role blends deep Medicare Part D/EGWP technical expertise with executive-level influence to drive profitable growth, enterprise value creation, and client retention/expansion. The Actuarial Principal leads the design of pricing proposals that balance market competitiveness and client-specific growth objectives with sustainable margins, risk controls, and long-term portfolio performance.
This role is intended to support our largest EGWP Third Party Administrator (TPA) by driving pricing strategies and analytics that help retain and grow mutual clients fully insured Medicare Part D business.
This individual partners across Sales, Account Management, Underwriting, Finance, Product, Supply Chain, and Legal—translating complex actuarial insights into clear, actionable recommendations for internal leadership and external clients. The role will also include actuarial analyses for Medicare Part D business, including but not limited to: special CMS programs, drug expense analyses and projections, financial forecasts, actuarial modeling, pharmacy network optimization strategies, manufacturer rebates optimization, regulatory impact assessment, and ad hoc actuarial analyses as needed.
Responsibilities of the Role:
EGWP Pricing Leadership & Proposal Development
- Own the pricing strategy, rate development and risk management for the Medicare Part D Fully Insured Employer Group Waiver Plan across new sales and renewals.
- Lead the creation and review of client pricing proposals, ensuring they are actuarially sound, compliant, and aligned with enterprise financial goals (margin, revenue, capital, risk appetite) and client growth goals (competitiveness, participation, retention).
- Collaborate with executive leadership to align actuarial insights with business goals. Present issues, opportunities and recommended solutions/strategies to leadership to better inform key decisions.
- Develop scenario-based pricing options (e.g., buy-downs, benefit changes, network levers, plan design alternatives), articulating trade-offs in profitability vs. growth.
Enterprise Value Optimization
- Drive portfolio-level financial performance through pricing discipline, risk management, and forward-looking assumption governance.
- Evaluate and recommend strategies that improve long-term enterprise value, including margin durability, volatility reduction, and scalable pricing processes.
- Partner with Finance and Regulated Markets leadership on annual planning, experience monitoring, and performance attribution (e.g., identifying drivers of favorable/unfavorable results).
Client Growth Enablement & Market Competitiveness
- Serve as a strategic partner to Sales and Account teams—helping craft winning proposals without compromising long-term economics.
- Provide market insights on competitive positioning, pricing approaches, and evolving EGWP dynamics to inform go-to-market strategy.
- Assimilate macro and micro trends, develop benchmarks, gather competitive intelligence to develop market competitive strategies.
- Participate in (or lead) external client meetings to explain pricing, answer questions, and negotiate terms with credibility and clarity.
Cross-Functional Influence & Collaboration
- Collaborate with external Third Party Administer (TPA) directly and in conjunction with Sales & Account Management and Regulated Markets on competitive pricing bids for Employer Group clients that align with overall retention and growth strategies.
- Provide actuarial input into overall product strategy, competitive positioning, taking into account the market dynamics and client/broker/TPA feedback.
- Translate complex actuarial findings into executive-ready narratives, including key drivers, risk considerations, and recommended actions.
- Perform financial analyses of proposed regulatory changes, demonstration programs, and other special programs by CMS to determine financial impact on various entities within the drug supply chain.
- Cross-functional collaboration within Express-Scripts/enterprise Medicare Part D financial and operational strategy development. Examples include:
- Advanced trend analytics
- Medical Loss Ratio (MLR) / member profitability projections
- Formulary Strategy
- Out of Pocket Cost
- Member risk score analysis / benchmarking
- Quantification of impact of regulatory proposals and changes
- Regulated Part D Health Plan Financial Reconciliation Support
Data Analysis, Governance & Modeling:
- Oversee development and refinement of actuarial models.
- Analyze large datasets to inform pricing, forecasting, and financial reporting.
- Ensure models and outputs align to internal policies, regulatory guidance, actuarial standards of practice, and appropriate controls.
- Oversee data integrity checks, experience studies, and assumption updates tied to emerging experience.
- Provide necessary pricing information for audit purposes or supplemental enhanced benefit regulatory requirements/filings.
- Develop and maintain actuarial models to aid in prospective projections of Medicare Part D Plan client’s plan liability and premium impact sensitivities.
- Drive continuous improvement in pricing tools, automation, and analytical approaches.
Required Qualifications:
- Associate of the Society of Actuaries (ASA) or Fellow of the Society of Actuaries (FSA) designation (FSA preferred).
- Bachelor’s degree in Actuarial Science, Mathematics, Statistics, Economics, or related field (or equivalent experience).
- 10+ years plus of actuarial experience in health insurance, with direct EGWP and/or Medicare pricing experience.
- May be required to travel periodically (for internal and external meetings)
- Strong technical skills in Excel, Access and actuarial modeling software.
- Demonstrated experience leading pricing strategy for complex accounts and influencing senior stakeholders.
- Strong expertise in pricing methodologies, trend development, credibility, and experience analysis.
- Proven ability to balance enterprise profitability objectives with market/client growth needs.
- Advanced analytical and modeling skills (Excel required; SAS/R/Python/SQL a plus).
- Exceptional communication skills—able to present to executives and negotiate with sophisticated client stakeholders.
- Demonstrate sound business judgment when drawing conclusions and making recommendations.
- Proven capabilities in modeling, forecasting, and predictive analytics.
- Extensive understanding of US Prescription drug supply chain and Medicare knowledge, with specific acumen in Part D, including but not limited to:
- Part D Bid Development, Desk Review & Audits
- CMS Regulatory Compliance / Reporting
- Financial Reconciliation Modeling
- Trend Analyses
- Formulary Modeling Experience
- Network Optimization Modeling
- Rebates Modeling
- Market Landscape analytics
- Risk Score Modeling
Preferred Qualifications:
- 5+ years plus prior experience with Pharmacy Benefit Management (PBM).
- Deep understanding of Medicare PDP market specific to EGWP plans.
- Experience with group retiree solutions, risk adjustment concepts, and employer segment dynamics.
- Familiarity with network contracting economics, PBM/pharmacy pricing, and benefit design levers.
- Prior experience developing standardized pricing frameworks and governance models across multiple markets or employer segments.
- Track record of leading through ambiguity and shaping strategy in evolving regulatory/market environments.
- Comfortable working in a fast-paced matrixed environment, balancing constant change/demands with efficient practices to maximize productivity.
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
For this position, we anticipate offering an annual salary of 145,500 - 242,500 USD / yearly, depending on relevant factors, including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus and long term incentive plan.
At The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, click here.
About Evernorth Health Services
Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you need a reasonable accommodation to complete the online application process, please email seeyourself@thecignagroup.com for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.
Cigna has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
