Actuarial Principal, EGWP Pricing & Strategy - Express Scripts - Remote

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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 Reconciliat