Medical Underwriting Subject Matter Expert

Rxadvance Corporation•Southborough, MA

6d•$90,000 - $135,860

About The Position

At Nirvana Health, we have the resources of a national carrier coupled with the unique flexibility and devoted service of a third-party administrator (TPA). Nirvana Health underwriting department supports the attainment of organizational goals through the issuance of prospective and existing business quotations and proposals. Including administrative fee pricing, stop loss, RFP questionnaire responses, and plan consultation. Medical Underwriter plays an important role in helping drive consistency and collaboration across the unit. The ideal candidate will bring a strong sense of ownership, the ability to work independently, a proactive approach to problem-solving and serving as a go-to resource for both internal partners and external stakeholders.

Requirements

5+ years of experience in underwriting, financial analysis, pricing methodologies, and/or funding arrangements.
2+ years of relevant medical insurance experience: brokers (producers), carriers, (TPA) third-party administrators, benefit analysis, underwriting, rating methodologies, or policy marketing, etc.
Strong analytical, decision-making, and communication skills.
Proficiency in Excel, Salesforce, Tableau, and/or VBA experience and Microsoft Office.
Experience communicating with outside consultants or customers.
Bachelor's degree required or equivalent years of related experience.

Responsibilities

Assists in preparing underwriting analysis and risk assessment for new and renewal business, including cases with significant benefit implications.
Assists in the preparation of quotes, questionnaires, and financial projections of varying complexity.
Apply underwriting guidelines and negotiate financial terms within assigned authority; escalate exceptions and financial variances to senior leadership as appropriate, balancing membership, revenue growth, and profitability.
Ensure pricing strategies align with business objectives and client needs.
Assist team members in navigating complex or sensitive sales and renewal situations.
Act as the central contact for final rate submissions (Final & Firm process), including reporting and coordination with the Operational Team.
Collaborate with Business Analysis, Sales, Client Management, and other internal stakeholders to support sales and retention efforts.
Present underwriting information and explain rate development, underwriting policies, and product standards to internal and external stakeholders.
Build and maintain relationships with stop loss carriers to support case resolution and negotiation efforts.
Clearly articulate Nirvana Health services, underwriting philosophy, and new initiatives to internal and external stakeholders.
Lead or contribute to departmental projects and continuous improvement initiatives aimed at enhancing productivity, accuracy, and customer service.
Identify and implement opportunities for automation and operational efficiency; influence the development of tools and resources.
Support the use and optimization of underwriting tools, systems, and reporting platforms.
Provide strategic input on stop loss placement, pricing, and product positioning.
Demonstrate deep knowledge of Nirvana Health product portfolio, underwriting philosophy, and market positioning.
Support the development of proposals that align with client goals and organizational strategies.
Analyze operational data and apply insights to financial modeling and fee development.
Serve as a trusted resource for internal partners on underwriting and stop loss strategy.