Pharmacy Underwriter Lead
Cambia Health Solutions

Spokane, Washington

This job has expired.


Pharmacy Underwriter LeadThe position can be anywhere in the states except for Colorado with a preference for candidates in our four Cambia states - OR, WA, ID, or UT


The Pharmacy Underwriter Lead will support both new and renewal case specific ASC (self-insured) Pharmacy Benefit Management (PBM) pricing. The Pharmacy Underwriter will be responsible for quoting and rating proposals and renewal projections. Acts as a subject matter expert providing guidance to the Underwriting team for Pharmacy rating.

Responsibilities:

  • Develop prospective and renewal pharmacy rates and terms (AWP discounts, rebates, and administrative fees) for group accounts in accordance with corporate and underwriting guidelines.

  • Collaborate with both internal and external colleagues in developing client-specific pharmacy pricing strategies.
  • Work with proposal unit to ensure responses, including pertinent definitions and caveats, to all RFPs are complete and accurate.
  • Support internal underwriting staff regarding pharmacy pricing questions.
  • Effectively communicate pharmacy pricing decisions to other departments when necessary.
  • Assist in the training process and mentoring of the Underwriting team related to pharmacy pricing.
  • Analyze data from the PBM underwriting staff to produce market appropriate proposals.
  • Contribute to the development of new pharmacy pricing formulas, methodologies, and guidelines.
  • Prepare pharmacy reporting to provide for book of business insights.
  • Assist with testing new pricing, underwriting and front-end systems as needed.
  • Ensure the proper administration of underwriting and legislative guidelines for new and renewing groups.
  • Achieve overall corporate financial goals by applying appropriate pharmacy pricing methodologies.
  • Build winning financial offers that balance internal profitability and ensure competitiveness in the market.
Additional responsibilities for the Lead level:
  • Serves as primary liaison with external PBM underwriting staff.
  • Serve as the primary point of contact and subject matter expert for the ASC pharmacy line of business in corporate and divisional underwriting project planning.
  • Represent Underwriting in Cambia workgroups and strategy sessions and serve as department representative where applicable.
  • Act as the liaison between various internal departments to ensure open communication and bring transparency to pharmacy underwriting functions.
  • Provide leadership in the improvement of pharmacy underwriting work processes as needed.
  • Consult with Legal and Pharmacy to ensure contractual terms, caveats, and other pertinent information is accurate and supports the offer as underwritten.
  • Partner with Legal to ensure final contract reflects the accepted financial offer.
  • Coordinate and support training as needed for pharmacy policies, procedures, and systems.
  • Support the development of and consistent administration of policies and procedures for ASC pharmacy pricing.
Minimum Requirements:
  • Prior experience with a major Pharmacy Benefit Manager, Health Plan, Pharmacy Brokerage or Consulting Practice.

  • Extensive knowledge of the health insurance and PBM industry and pricing practices.
  • Demonstrated detailed knowledge of PBM pricing and concepts, including complex terms and conditions and their impact on the overall offer position.
  • Successfully demonstrated skills and experience in underwriting and pricing of various funding options and products.
  • Ability to build and maintain positive internal and external customer interactions.
  • Demonstrated attainment of a high level of independent, consistent performance.
  • Ability to organize, plan, prioritize and complete complex assignments with little or no supervision.
  • Demonstrated high level of attention to detail and quality.
  • Proven understanding of business, including finance, accounting, economics, and risk management.
  • Demonstrated ability to read the marketplace and competitive environment.
  • Ability to prioritize tasks and meet deadlines.
  • Effective verbal and written communications.
  • Strong team player with a customer service approach.
  • Demonstrated technology proficiency, including Excel, Word, Teams and applicable software applications.
Additional Minimum Requirements for Lead:
  • Exceptional communication skills, ability to distill complex material into easy-to-understand presentations, effectively respond to questions, and engage a variety of audiences.
  • Experience developing and improving existing best practices for pharmacy underwriting.
  • Demonstrated project management skills for complex projects.
  • Acts as a pharmacy underwriting resource to leadership to support key initiatives.
  • Highly developed business acumen in finance, accounting, economics, and risk management.
  • Ability to negotiate with internal and external partners to achieve optimal outcomes.
  • Demonstrated success in oversight of work and providing effective guidance on process and practice.
Normally to be proficient in the competencies listed above:

Pharmacy Underwriter Lead would have a Bachelor's degree in business, math, statistics or related discipline and a minimum of 8+ years related experience or an equivalent combination of education and experience.

This position includes 401(k), healthcare, paid time off, paid holidays, and more. For more information, please visit www.cambiahealth.com/careers/total-rewards.

We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A drug screen and background check are required.

If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy.


This job has expired.
Job Alerts

Provide an email, zip code for jobs, and/or job category to subscribe to job alerts. Learn more now.


*By subscribing, you agree to our Terms and Privacy Policy.

More Health and Safety jobs


Mental Health Center of Denver
Denver, Colorado
Posted about 1 hour ago
Mental Health Center of Denver
Denver, Colorado
Posted about 1 hour ago
Mental Health Center of Denver
Denver, Colorado
Posted about 1 hour ago
View Health and Safety jobs ยป