Medical Underwriting Strategy & Validation Expert

Rxadvance Corporation; Southborough (MA); On-site; USD 90,000 - 136,000; Full time

Job summary

Rxadvance Corporation (nirvanaHealth) is building a multi-tenant rating and quote-to-installation platform for U.S. commercial health insurance—Small Group and Large Group, Fully-Insured through Level-Funded and Self-Funded.

The rating engine serves as the pricing brain, producing per-member, per-tier, and composite rates with an explainability waterfall. The role focuses on specifications, validation, and close alignment with filings and regulation.

Qualifications

• Bachelor’s degree in accounting, mathematics, finance, or similar fields required.
• 5+ years of total experience with medical underwriting in a health plan or managed care setting.
• Experience building manual rate models: base claims development, trend, area and demographic factors, industry loads.
• Ability to explain why policy changes impact premiums (deductible, OOP leverage, etc.).
• Familiarity with ACA small-group rules and rate-filing literacy.

Responsibilities

• Reverse-engineer carrier rate filings into precise, implementable factor specifications.
• Build member-level worked examples in Excel, with traceable sources for the engine’s regression fixtures.
• Own methodology for the manual rating pipeline: base claims, trend, area factors, demographic factors, industry loads, and CPD waterfall for deductibles, copays, coinsurance, and OOP maximums.
• Maintain ACA small-group pipeline accuracy: single risk pool, age curves, family build-up, and prohibited factors enforcement.
• Review engine output against worked examples and resolve discrepancies with the engineering team.
• As the platform scales: translate carrier methodologies into platform abstractions for level-funded products.

Skills

Actuarial underwriting

Rate filings literacy

Credibility theory

Documentation habit

Collaboration with engineers

Education

Bachelor’s degree in accounting, mathematics, finance, or similar

Tools

Excel

Job description

Rxadvance Corporation (nirvanaHealth) is building a multi-tenant rating and quote-to-installation platform for U.S. commercial health insurance—Small Group and Large Group, Fully-Insured through Level-Funded and Self-Funded.

The rating engine serves as the pricing brain, producing per-member, per-tier, and composite rates with an explainability waterfall. The role focuses on specifications, validation, and close alignment with filings and regulation.