VP, PBM Underwriting
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Job Description
VP leading PBM underwriting, pricing, and renewals for Rightway, a healthcare technology company guiding patients to better care and medications. Managing risk strategy and underwriting teams.
Responsibilities:
- Lead underwriting for new business, RFPs, and renewals
- Set underwriting guidelines, approval thresholds, and risk tolerances
- Decide when to push back, price for risk, or walk away
- Analyze claims and plan data to identify cost drivers, assess risk, and forecast financial performance
- Work with Legal, Finance, and Sales on contract terms and guarantees
- Monitor book-of-business performance against pricing assumptions
- Improve future pricing and renewal strategy
- Partner with cost of goods, pharmacy network, and rebate teams on pricing and contract economics
- Advocate for Rightway’s pricing models to clients, brokers, consultants, and executive leadership
- Build, coach, and develop a high-performing underwriting team
- Set standards for rigor, speed, and documentation
- Report pricing performance, win/loss trends, renewal outcomes, and risk exposure to the executive team
- Perform other duties as assigned
Requirements:
- 10+ years of experience in PBM underwriting, pharmacy pricing, healthcare analytics, or actuarial work, including 5+ years leading teams
- Deep knowledge of PBM economics, including rebates, pharmacy network pricing, drug acquisition costs, fee structures, and guarantee design
- Strong financial modeling skills
- Comfort working with large claims datasets using SQL, Excel, and BI tools
- Track record pricing complex, large-employer or consultant-led deals
- Sound judgment under uncertainty, with confidence to make and defend a call
- Clear communication with technical and non-technical audiences
- Bachelor's degree in finance, actuarial science, economics, pharmacy, or a related field
- Actuarial credential (ASA, FSA, or MAAA) is extra credit
- Experience at a PBM, health plan, consultancy, or pharmacy-focused analytics firm is extra credit
- Experience with pass-through or fully transparent pricing models is extra credit
- Experience building underwriting tools or automating pricing workflows is extra credit
Benefits:
- Bonus
- Equity
- Equal Opportunity Employer
- Inclusive culture where differences are celebrated
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