Senior Underwriting Analyst

EmpiRx Health, LLC• US,

5d•Hybrid

About The Position

EmpiRx Health is the leading clinically-driven pharmacy benefits management company. As the pioneer in value-based pharmacy care, EmpiRx Health puts its customers and members first by enabling them to take control of their pharmacy benefits, healthcare outcomes, and financial results. We place more emphasis on member care than any other PBM by focusing on health outcomes first. Our pharmacists and clinicians are at the center of everything we do―and our population health solution delivers tailored strategies for our clients. Leveraging our newly launched, AI-powered pharmacy care platform, Clinically™, EmpiRx Health’s pharmacists and client experience teams provide the highest quality pharmacy care to our clients and their members. This enables benefits plan sponsors to keep their members healthy, happy, and productive, while substantially reducing prescription drug spending, which has been on an explosive growth trajectory in recent years. EmpiRx Health is in unprecedented growth, and we're seeking a highly skilled and experienced Senior Underwriter, Pharmacy Benefits. In this critical role, The Senior Underwriter, Pharmacy Benefits will independently lead financial underwriting for complex new-business RFPs, renewals, market checks, and BAFOs. This role converts pharmacy claims, benefit design, pricing terms, guarantees, rebates, fees, and clinical strategies into clear financial recommendations that protect client value and EmpiRx Health’s margin. The Senior Underwriter owns work from data intake through approved handoff, applies rigorous quality controls, and partners early across commercial, clinical, financial, contracting, implementation, and technology teams.

Requirements

Bachelor’s degree or equivalent combination of relevant education and experience.
5+ years of progressive experience in pharmacy-benefit, health-plan, healthcare, or related financial underwriting, pricing, actuarial support, FP&A, or financial analytics.
Demonstrated hands-on experience with PBM or health-plan claims and pricing fundamentals, plus advanced Microsoft Excel skills.
Demonstrated experience with guarantee design or reconciliation and client P&L or margin decisions.
Strong written and verbal communication skills, including the ability to present assumptions, risk, tradeoffs, and recommendations to leadership.
Track record of independently leading complex RFP, renewal, market-check, or pricing work with strong accuracy and timeliness while collaborating across commercial, clinical, financial, contracting, and implementation teams.

Nice To Haves

Experience at a mid-market or large PBM, pharmacy-benefit aggregator, advisor or broker, health plan, employer benefits organization, specialty pharmacy, or other pharmacy-benefit partner.
Health-plan underwriting experience that includes both deal underwriting and financial reporting.
Experience with rebates, formulary and channel economics, specialty or pipeline risk, or downside and concentration analysis.
Experience building technical controls, audit trails, SOPs, or automated underwriting workflows.
Experience with Salesforce Sales Cloud and Tableau, Domo, or comparable tools.
Master’s degree in finance, Mathematics, Statistics, Health Economics, or a related field.

Responsibilities

Independently develop pricing and underwriting strategies for complex RFPs, renewals, market checks, and BAFOs.
Interpret pharmacy claim fields, benefit rules, pricing benchmarks, discounts, fees, spread, rebates, formulary and channel economics, and member cost share.
Validate census, claims, and RFP inputs; reconcile totals; and document assumptions and transformations.
Build and explain base, upside, and downside scenarios, including trend, utilization, mix, specialty exposure, and break-even assumptions; translate results into a clear recommendation, alternatives, and escalation points.
Design, model, and reconcile discount, dispensing-fee, rebate, PMPM, trend, performance, and clinical-savings guarantees, including definitions, exclusions, true-ups, and shortfall exposure.
Integrate claims economics, rebates, fees, clinical revenue, commissions, and allocations into client P&L and margin analysis.
Quantify concessions and recommend approval, escalation, or alternative deal structures.
Identify low-credibility, high-cost, specialty, concentration, and asymmetric risks that averages may obscure.
Align modeled intent with RFP questionnaire responses, pricing exhibits, disruption reports, contracts, amendments, and implementation requirements.
Manage multiple concurrent opportunities within established turnaround standards while maintaining at least 95% accuracy.
Establish objectives, required inputs, roles, timelines, and decision points with Sales, Client Engagement, Proposals, Clinical, Network, Rebate, and Risk.
Present assumptions, financial tradeoffs, and recommendations to business partners and leadership; respond to BAFO and follow-up questions with minimal guidance.
Produce an approved handoff record of modeled terms, definitions, assumptions, and exceptions for Contracting and Implementation; connect actual performance and recurring tool needs with FP&A, Product, and Engineering.
Independently re-perform key calculations and tie out inputs, classifications, assumptions, and outputs before release.
Maintain reproducible workpapers, source files, versions, approvals, definitions, and claim-level traceability.
Follow controlled model releases and regression testing; improve controls, SOPs, templates, and workflows; and complete lookbacks that convert actual-versus-underwritten variances into better assumptions and methods.