Executive Director, Actuarial - Medicare Network

Executive Director, Actuarial

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.

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.

• 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

• 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

• 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…