Medical and Pharmacy Underwriter and Financial Analyst

#LI-CM #LI-Remote

About the role:

We are seeking a Medical & Pharmacy Underwriter with a strong actuarial background to join our growing team. This role is responsible for evaluating risk, pricing group medical and pharmacy benefit programs, and supporting the development of innovative pricing strategies. The ideal candidate has deep knowledge of healthcare trends, pharmacy cost drivers, and actuarial modeling techniques, with a proven ability to balance risk and competitiveness in pricing decisions.

Essential Functions and Primary Duties

• Risk Assessment & Underwriting

• Review and analyze medical and pharmacy claims experience, demographic data, and plan design details to assess risk.

• Develop and deliver accurate renewal calculations, new business quotes, and stop-loss evaluations.

• Collaborate with sales, account management, and product teams to develop competitive pricing strategies

• Actuarial Analysis

• Build, refine, and maintain actuarial models to support pricing and forecasting efforts.

• Monitor emerging healthcare and pharmacy trends to incorporate into underwriting assumptions.

• Conduct experience studies and recommend adjustments to rating assumptions as needed.

• Financial Performance & Reporting

• Provide insight into book-of-business performance, loss ratios, and trend development.

• Prepare and present analyses to internal stakeholders and senior leadership.

• Support financial forecasting and budget-setting initiatives.

• Collaboration & Compliance

• Partner with compliance and regulatory teams to ensure adherence to state and federal requirements.

• Act as a subject-matter expert on risk, pricing methodology, and market competitiveness.

Preferred Qualifications

• Bachelor's Degree in Actuarial Science, Economics, Statistics, or other math-oriented degrees
• One or more years of underwriting and/or actuarial healthcare experience
• Two or more actuarial exams passed
• Must possess analytical skills (mathematics and statistics)
• 3+ years of experience in medical, pharmacy, or health insurance underwriting.
• Hands-on experience with actuarial pricing models, trend analysis, and financial forecasting.
• Familiarity with PBM (Pharmacy Benefit Manager) contracts, formulary management, and specialty drug cost trends is highly desirable.
• Must be able to comprehend, manipulate, and interpret statistical data
• Demonstrated ability to communicate verbally and in writing throughout all levels of organization, both internally and externally
• Experience with SQL, R, Python, VBA, M and SAS or other data analysis tools

Minimum Qualifications Required

• High School Diploma or GED required; Bachelor's degree preferred with emphasis in math, statistics or finance.

• Up to 6 years of experience in benefit analysis for group employee benefits.

• Must have the ability to compile, analyze, present, interpret financial and statistical information to facilitate decision making.

• Must maintain current required licenses and certifications relevant to field of expertise.

• Technical knowledge relative to industry and incorporating contract provisions, renewal and claims processing, plan knowledge and carrier funding.

• Expertise in managing clients with alternative funding arrangements.

• Advanced skill in using computer application software for financial modeling, statistical analysis and spreadsheet calculations.

• Expert knowledge of state and federal legislation.

• Sets priorities and manages work flow to ensure efficient, timely and accurate deliverables.

• Demonstrated ability to communicate verbally and in writing throughout all levels of the organization, both internally and externally.

• Advanced problem solving and critical thinking skills.

• Must be able to travel based on client and business needs.