Director of Underwriting

Office Ally•Brentwood, TN

About The Position

Office Ally is hiring its first Director of Underwriting to build and manage the credit function for OA Advance, a new working capital product. This role reports to the SVP and GM of Payments and is a high-impact, high-autonomy founding position with complete ownership of underwriting policy, decisioning, portfolio monitoring, and the operational discipline necessary for responsible and profitable working capital extension. OA Advance assesses submitted insurance claims for payment likelihood and advances a portion of the expected reimbursement directly to the practice's bank account. Upon payer remittance and receipt of an 835, the advance plus program fees are automatically recouped. The program integrates proprietary clearinghouse data, machine learning, and embedded finance to address a persistent cash flow challenge in healthcare. This position is ideal for a pragmatic, business-minded credit professional who excels at building a function from scratch, enjoys the intersection of healthcare revenue cycle and commercial lending, and desires deep involvement in the operations of a growth-stage healthcare technology company.

Requirements

7+ years of underwriting experience, with at least 3 years in commercial, asset-based, factoring, or specialty business credit (not exclusively consumer).
Demonstrated ownership of a credit policy — you have written one, defended it, and revised it based on portfolio performance.
Working knowledge of ECOA / Regulation B, FCRA, OFAC screening, and adverse action requirements.
Fluency with the Expected Loss framework (PD × LGD × EAD) and the ability to translate it for non-credit stakeholders.
Hands-on experience operating an underwriting platform end-to-end (MidDesk, TurnKey Lender, HES LoanBox, or comparable factoring/lending workbench).
Comfort with data: you can pull a query, read a model output, and challenge a data scientist on whether a score makes sense.
Excellent written communication — you will be writing policy, decision rationales, and executive memos.
Highly organized, self-directed, and comfortable building a function from zero rather than inheriting a mature one.
Problem-solving skills and a business-practical mindset are paramount.

Nice To Haves

Bachelor’s degree
Direct healthcare experience: 837/835 transaction sets, ERA reconciliation, payer mix analysis, denial code taxonomy, and the NPI registry.
Experience underwriting medical practices or healthcare receivables specifically (e.g., at a medical factor or healthcare fintech).
Familiarity with UCC Article 9, security interests in healthcare receivables, and Medicare/Medicaid anti-assignment rules.
Prior role in a startup, new product launch, or “founding underwriter” capacity — comfort with ambiguity.
Track record of building and managing a small underwriting team.
Prior experience in a PE-backed or growth-stage company environment.

Responsibilities

Own the practice-level underwriting decision for OA Advance applicants, including oversight of auto-approval and management of the manual review queue.
Configure and operate the underwriting workbench, encompassing bureau pulls, UCC searches, OFAC screening, KYB verification, and continuous monitoring alerts.
Establish and maintain the manual review playbook, decision documentation standards, and audit trail practices necessary for responsible program scaling.
Take ownership of the underwriting policy and rigorously test all thresholds against historical Office Ally clearinghouse data.
Lead quarterly policy reviews and recommend threshold adjustments based on vintage analysis.
Collaborate with the AI/ML team to refine the practice-level risk score and validate weights against portfolio performance.
Establish processes for vintage analysis, concentration monitoring, and active portfolio monitoring.
Monitor portfolio-level KPIs, including approval rate, auto-decision rate, default rate, loss given default, and time-to-decision.
Triage continuous monitoring alerts such as UCC filings, NPI status changes, claim volume drops, and denial rate increases.
Proactively identify policy and process gaps before regulators or losses do.
Serve as the credit officer of record for OA Advance, capable of defending decisions to auditors, examiners, or executives.
Partner with Legal and Compliance on fair lending, disparate impact testing, and maintaining the PHI firewall between underwriting data and patient clinical data.
Maintain the audit-readiness posture for the function, including documented policy, immutable decision logs, reason code mapping, and reviewer accountability.
Manage the relationship with the underwriting platform vendor, including SLA performance, monitoring rule customization, and renewal terms.
Collaborate closely with the AI/ML team (claim-level scoring), Infrastructure team (data pipeline and rules engine), Product (program economics), and Sales/Operations (applicant pipeline).
Translate underwriting performance and risk posture into clear executive-level reporting.