VP, PBM Underwriting

🔥 12 hours ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $210k - $250k / year

⏰ Full Time

🔴 Lead

📋 Underwriter

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Rightway

WebsiteLinkedInAll Job Openings

201 - 500 employees

🏥 Healthcare

⚕️ Healthcare Insurance

☁️ SaaS

💰 $100M Series C on 2021-03

Healthcare • Healthcare Insurance • SaaS

Rightway is a healthcare company focused on providing care navigation and pharmacy benefits management solutions. It specializes in helping employers and health systems lower healthcare costs and improve outcomes through personalized, proactive clinical support and transparent pharmacy benefits management. Rightway offers a human-first approach, providing real-time, one-on-one support to members to help them make better healthcare decisions and navigate the complexities of healthcare systems. The company aims to reduce healthcare costs while improving employee satisfaction with healthcare services.

📋 Description

• Lead underwriting for new business, RFPs, and renewals • Set underwriting guidelines, approval thresholds, and risk tolerances • Decide when to push back, price for risk, or walk away • Analyze claims and plan data to identify cost drivers, assess risk, and forecast financial performance • Work with Legal, Finance, and Sales on contract terms and guarantees • Monitor book-of-business performance against pricing assumptions • Improve future pricing and renewal strategy • Partner with cost of goods, pharmacy network, and rebate teams on pricing and contract economics • Advocate for Rightway’s pricing models to clients, brokers, consultants, and executive leadership • Build, coach, and develop a high-performing underwriting team • Set standards for rigor, speed, and documentation • Report pricing performance, win/loss trends, renewal outcomes, and risk exposure to the executive team • Perform other duties as assigned

🎯 Requirements

• 10+ years of experience in PBM underwriting, pharmacy pricing, healthcare analytics, or actuarial work, including 5+ years leading teams • Deep knowledge of PBM economics, including rebates, pharmacy network pricing, drug acquisition costs, fee structures, and guarantee design • Strong financial modeling skills • Comfort working with large claims datasets using SQL, Excel, and BI tools • Track record pricing complex, large-employer or consultant-led deals • Sound judgment under uncertainty, with confidence to make and defend a call • Clear communication with technical and non-technical audiences • Bachelor's degree in finance, actuarial science, economics, pharmacy, or a related field • Actuarial credential (ASA, FSA, or MAAA) is extra credit • Experience at a PBM, health plan, consultancy, or pharmacy-focused analytics firm is extra credit • Experience with pass-through or fully transparent pricing models is extra credit • Experience building underwriting tools or automating pricing workflows is extra credit

🏖️ Benefits

• Bonus • Equity • Equal Opportunity Employer • Inclusive culture where differences are celebrated

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