Underwriter - Pharmacy; Remote

Resp & Qualifications

Purpose: Responsible for the attainment, effective management, and profitability of a designated book of business. This position utilizes underwriting judgment and exercises a level of authority. Pricing concessions are permitted up to the designated level of authority without further review. This position works closely with Sales and Account Management to ensure that client needs are met without compromising the corporate objectives.

This position is responsible for monitoring financial performance and apprising management as needed. Responsibilities also include pharmacy related underwriting functions, such as evaluating pharmacy benefit structures, reviewing high‑cost drug utilization and trends, assessing risk tied to specialty medications, and collaborating with Pharmacy Benefits Management (PBM) partners to ensure appropriate pricing, risk mitigation, and compliance.

• Ensure the retention and profitability of existing business through the calculation of appropriate renewal rates. Utilizes all currently available information, factors and formulae to accurately predict future claims and non‑claims expenses. Works closely with the senior level underwriters and management to provide alternate benefit plans, risk and/or funding arrangements. Update appropriate billing rate files, contracts, internal databases, etc. The renewal process includes the following requirements: completing group risk renewals, completing ASO/Stop Loss renewals, quoting alternate benefits designs, funding arrangements, provide clear documentation/file maintenance.
  
  Utilize the latest actuarial tables and factors. Performs settlement review as necessary.
• Support attainment of corporate sales and profitability goals through the completion of new business quotes (e.g. demographics, claims experience, benefit levels, contribution strategy, carrier history, etc.) and the development of appropriate new business rates. The new business quote process includes the following requirements: completing basic (Demographically Rated) quotes, completing complex (Experience Rated) quotes, completing Stop Loss and ASO quotes, applying underwriting judgment when appropriate (with assistance from Management), preparing RFP responses (with assistance from Senior Underwriters, Underwriting Consultants or Management), meeting the stated close ratio goals and average turnaround time goals, providing clear documentation and file maintenance, using the latest actuarial tables and factors.
• Monitor financial performance of assigned book of business to provide advance notice of potential adverse outcomes to Underwriting Department management. Provide technical expertise and support to Account Managers regarding potential benefit changes and/or alternatives available to the account. Ensure account performance is accurately reflected on corporate financial statements and forecasts.
• Provide support to Sales and Account Management staff on underwriting related issues. Provide support to Finance, Legal, Operations, etc. as requested. Necessary support includes communicating and negotiating directly with prospects, existing accounts, brokers & consultants; participating in conference calls with prospects, existing accounts, brokers & consultants (with assistance from Management); attending meetings with prospects, existing accounts, brokers and consultants (with assistance from Management);
  
  performing miscellaneous functions that support the department as needed.
• Participate in formal and informal training activities to develop and enhance knowledge of underwriting methodologies, funding options, products, legislation, Care First competitors, and to ensure compliance with corporate and departmental policies. Necessary training includes internal and external courses, providing training support, mentoring and coaching to associate underwriters, becoming proficient in new underwriter tools and applications, and continuing to improve computer skills.
• Participate and have an active role in department special projects, while embracing change in a positive manner.
• Produce and monitor the issuance of underwriting…