Mgr,Medical Underwriter

CVS Health • Hartford, CT

11d • Hybrid

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary As the Manager, Medical Underwriting, you will use your clinical expertise to support Aetna’s underwriting decisions and strategic goals by evaluating and managing medical risk. In this role, you’ll partner closely with underwriting and account teams to assess new and renewal large group cases, review high‑cost claims, and project future medical costs based on diagnosis and prognosis. You’ll serve as a clinical consultant to Medical Underwriters, providing guidance on cases and appeals, approving or denying requests, and ensuring claim ranges are clinically appropriate. You’ll also conduct clinical audits and share educational feedback to support sound underwriting decisions with meaningful benefit implications. In addition, you will participate in project work groups including process improvement initiatives. This is a hybrid role if located in or near the Hartford area or remote if located elsewhere.

Requirements

• Registered Nurse, highly technical, analytical clinician with sound understanding of underwriting risk assumptions.
• Active Registered Nurse certification.
• This role does not support sponsorship
• Anticipated Weekly Hours 40
• Time Type Full time

Nice To Haves

• 3 - 5 years of experience in medical underwriting and risk assessment.

Responsibilities

• support Aetna’s underwriting decisions and strategic goals by evaluating and managing medical risk
• partner closely with underwriting and account teams to assess new and renewal large group cases, review high‑cost claims, and project future medical costs based on diagnosis and prognosis
• serve as a clinical consultant to Medical Underwriters, providing guidance on cases and appeals, approving or denying requests, and ensuring claim ranges are clinically appropriate
• conduct clinical audits and share educational feedback to support sound underwriting decisions with meaningful benefit implications
• participate in project work groups including process improvement initiatives

Benefits

• This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families.
• The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
• Additional details about available benefits are provided during the application process and on Benefits Moments.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: No Education Listed
• Number of Employees: 5,001-10,000 employees