Senior Manager, Medical Underwriter

CVS Health•Work At Home-New Jersey, ID

17d•$67,900 - $182,549•Onsite

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. A Brief Overview Leads medical underwriting strategy and execution within Aetna's Supplemental Health Large Group division, managing risk evaluation and financial performance for the MedPremier/Boon fully insured medical product portfolio. Directs a small team of underwriters responsible for new business quoting, renewal management, and broker engagement across large group accounts. Ensures rate adequacy and loss ratio performance align with divisional financial targets while delivering competitive, broker-ready proposals. Partners closely with actuarial leadership on pricing governance and escalated case approvals within a tiered underwriting authority framework.

Requirements

5+ years of large group medical underwriting experience, including full-cycle responsibility for both new business and renewals
Demonstrated fluency in medical underwriting financials: loss ratios, PMPM trends, IBNR/completion factors, credibility, and rate adequacy analysis
Experience managing broker/consultant relationships in a competitive, multi-carrier environment
Proficiency with group medical rating tools and UW case management platforms
Strong written communication skills for executive-ready memos, broker-facing proposals, and escalation summaries
Adept at execution and delivery — managing competing priorities and turnaround deadlines in a high-volume environment
Mastery of problem solving and decision-making under uncertainty, with comfort operating within a delegated authority framework
Bachelor's degree required

Nice To Haves

Concentration in mathematics, finance, actuarial science, or business preferred
Relevant professional qualification (ALHC, FLHC) a plus

Responsibilities

Directs medical underwriting operations for the MedPremier/Boon medical book, setting case-level standards for new business evaluation, renewal rate actions, and exception management consistent with divisional pricing governance.
Evaluates large group medical RFPs end-to-end: census and plan design review, actuarial rate alignment, competitive positioning, and final proposal packaging for brokers and consultants.
Manages annual renewal cycle for the assigned medical book — experience pulls, loss ratio analysis, rate action recommendations, and broker negotiation — with proactive intervention on accounts running above target loss ratios.
Partners with the Actuarial team to align filed rates with emerging experience, escalate cases outside delegated authority, and support WD5 financial close reporting on earned premium and incurred claims.
Approves medical underwriting exceptions and financial variances within delegated authority; escalates cases to the Lead Director and VP Supplemental Health per premium-tier thresholds.
Leads broker and consultant-facing engagements, including BAFO presentations, experience reviews, and renewal negotiations — representing Aetna's underwriting rationale with clarity and credibility.
Collaborates cross-functionally with Sales, Enrollment Operations, Commissions, and Compliance to support plan implementations, QLE administration, and regulatory requirements unique to the FI medical segment.
Manages team performance, workflow prioritization, and development for two direct reports, balancing turnaround SLAs against case complexity and account ownership.