Pharmacy Underwriter II

Medica•Minnetonka, MN

7h•$78,700 - $134,900•Hybrid

About The Position

Medica is a nonprofit health plan serving over a million members across Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We focus on delivering personalized healthcare experiences and collaborating with providers to ensure members receive quality care. Our team values accountability, data-driven decisions, continuous learning, and collaboration. Our mission is to support our members and employees during life's important moments, fostering a community of connected care where quality service is standard and every member feels valued.

Requirements

Bachelor's degree or equivalent experience in a related field
3+ years of work experience beyond degree

Nice To Haves

Complete working knowledge and skill with ability to be fully proficient in professional field
5 years+ of underwriting/pricing experience; strongly preferred within the PBM industry or pharmacy underwriting at a Health Plan
Pharmacy pricing and RFP experience
Ability to negotiate, influence, and persuade
Ability to multi-task between cases and projects
Strong knowledge of Microsoft Excel
Exceptional written and interpersonal communication skills; presentation skills
Knowledge of SalesForce
Strong financial acumen and analytical skills, with the ability to translate insights into business impacts and actionable next steps
Ability to analyze and use qualitative and quantitative data and incorporates understanding into decision criteria
In-depth understanding of the various Legal and Compliance implications within PBM to ensure risk mitigation
Ability to utilize relationship development skills, organizational skills, diplomacy, assertiveness and focus to collaboratively drive for results in a cross-functional environment
Advocate for best practices and continuous learning

Responsibilities

Manage financial analysis, risk assessment, and underwriting consult of pharmacy Request for Proposals (RFPs) for Medica self-insured employer groups.
Consult with internal partners to develop strategies for competitive pharmacy price proposals to retain and win new employer group lives.
Interact with external pharmacy partners to support Medica pharmacy proposals, including negotiating pharmacy guarantees and contracts with clients, brokers, and consultants.
Identify key characteristics of commercial clients to develop alternative pharmacy pricing strategies and provide alternative pricing models for RFPs.
Lead complex pharmacy RFPs for key/strategic cases.
Manage financial analysis, risk assessment, and pricing for new business and renewals involving alternative pharmacy pricing models.
Communicate and explain the rationale of pricing recommendations for pharmacy RFPs to Medica’s Commercial sales, Underwriting, and Pharmacy teams.
Run client-level rebate projections to support underwriting for pharmacy RFPs.
Collaborate with RFP and Underwriting teams to complete pharmacy RFP questionnaires.
Serve as a pharmacy pricing subject matter expert to Medica’s Underwriting Team.
Maintain awareness of competitive Commercial pharmacy pricing models and strategies in the marketplace.
Perform quality assurance of Advanced Pricing Management group setup.
Review annual client pharmacy guarantee reconciliations for reasonableness, accuracy, and results.
Track competitive intelligence and consultant playbooks for Underwriting.
Participate in departmental training forums, including providing training to internal staff (pharmacy pricing training to Sales and Underwriting, new staff training).
Mentor new underwriters in pharmacy pricing and provide consultation to less experienced staff.
Develop and deliver training materials on pharmacy pricing strategies and underwriting processes to internal partners.
Support Underwriting and Pharmacy teams as needed and requested by manager.
Participate in committee work as assigned by manager.
Actively participate in internal and external commercial pharmacy, client, and underwriting meetings.