Medical Underwriting Subject Matter Expert

Mass Digital Health; Southborough (MA); On-site; USD 90,000 - 136,000; Full time

Job summary

nirvanaHealth is hiring a Medical Underwriter to support underwriting analysis, risk assessment, and pricing for new and renewal business. You will prepare quotes, respond to RFPs, and collaborate with sales, client management, and operations to ensure pricing aligns with client needs.

The role emphasizes ownership, independence, proactive problem-solving, and serving as a go-to resource for internal and external stakeholders. 40 hours weekly; full-time position.

Qualifications

• 5+ years of underwriting, financial analysis, pricing methodologies, and/or funding arrangements.
• 2+ years of relevant medical insurance experience: brokers, carriers, TPAs, benefit analysis, underwriting, rating methodologies, or policy marketing.
• Strong analytical, decision-making, and communication skills.
• Proficiency in Excel, Salesforce, Tableau, and/or VBA experience and Microsoft Office.
• Experience communicating with outside consultants or customers.

Responsibilities

• Assists in preparing underwriting analysis and risk assessment for new and renewal business, including cases with significant benefit implications.
• Assists in the preparation of quotes, questionnaires, and financial projections of varying complexity.
• Apply underwriting guidelines and negotiate financial terms within assigned authority; elevate exceptions and variances to senior leadership as appropriate.
• Ensure pricing strategies align with business objectives and client needs.
• Assist team members in navigating complex or sensitive sales and renewal situations.
• Act as the central contact for final rate submissions and coordination with the Operational Team.
• Collaborate with Business Analysis, Sales, Client Management and other stakeholders to support sales and retention.
• Present underwriting information and explain rate development, policies, and product standards to internal and external stakeholders.
• Build and maintain relationships with stop loss carriers to support case resolution and negotiation.
• Clearly articulate Nirvana Health services, underwriting philosophy, and new initiatives to internal and external stakeholders.
• Lead or contribute to departmental projects and continuous improvement initiatives to enhance productivity, accuracy, and customer service.
• Identify and implement opportunities for automation and operational efficiency; influence development of tools and resources.
• Support the use and optimization of underwriting tools, systems, and reporting platforms.
• Provide strategic input on stop loss placement, pricing, and product positioning.
• Demonstrate deep knowledge of Nirvana Health product portfolio, underwriting philosophy, and market positioning.
• Support development of proposals aligning with client goals and organizational strategies.
• Analyze operational data and apply insights to financial modeling and fee development.
• Serve as a trusted resource for internal partners on underwriting and stop loss strategy.

Skills

Underwriting

Financial analysis

Pricing methodologies

Funding arrangements

Analytical skills

Communication skills

Excel

Salesforce

Tableau

VBA

Microsoft Office

Education

Bachelor's degree

Tools

Excel

Salesforce

Tableau

VBA

Microsoft Office

Job description

Job Posting Title

Medical Underwriter

Job Description

Company Overview:

Join us in our mission to transform healthcare! nirvanaHealth (under RxAdvance Corp.) is committed to bringing the art of the possible to the payer and PBM industries. We invest in our employees at every stage of life. Success radiates across all levels of our organization, driven by competitive benefits and a strong focus on employee wellness, we aim to support all aspects of employee growth.

Characterized by curiosity, innovation, and an entrepreneurial mindset, nirvanaHealth is the first to offer medical and pharmacy benefit management solutions that run on the same platform, made possible by our creation, Aria – the first robotic process automation cloud platform designed for healthcare.

Under the leadership of our Chairman John Sculley, former Apple CEO, and our President & CEO Ravi Ika, nirvanaHealth endeavors to sizably reduce the $1 trillion in waste in healthcare administrative and medical costs. We are seeking self‑determined players to join our team – folks who embrace the grind and hustle of a growing company, are collaborative and innovative, are life‑long learners and growers, and have an entrepreneurial and positive mindset.

Job Summary

At Nirvana Health, we have the resources of a national carrier coupled with the unique flexibility and devoted service of a third‑party administrator (TPA).

Nirvana Health underwriting department supports the attainment of organizational goals through the issuance of prospective and existing business quotations and proposals. Including administrative fee pricing, stop loss, RFP questionnaire responses, and plan consultation.

Medical Underwriter plays an important role in helping drive consistency and collaboration across the unit. The ideal candidate will bring a strong sense of ownership, the ability to work independently, a proactive approach to problem‑solving and serving as a go‑to resource for both internal partners and external stakeholders.

Responsibilities

Underwriting & Risk Assessment

• Assists in preparing underwriting analysis and risk assessment for new and renewal business, including cases with significant benefit implications.
• Assists in the preparation of quotes, questionnaires, and financial projections of varying complexity.
• Apply underwriting guidelines and negotiate financial terms within assigned authority; elevate exceptions and financial variances to senior leadership as appropriate, balancing membership, revenue growth, and profitability.
• Ensure pricing strategies align with business objectives and client needs.
• Assist team members in navigating complex or sensitive sales and renewal situations.

Collaboration & Communication

• Act as the central contact for final rate submissions (Final & Firm process), including reporting and coordination with the Operational Team.
• Collaborate with Business Analysis, Sales, Client Management, and other internal stakeholders to support sales and retention efforts.
• Present underwriting information and explain rate development, underwriting policies, and product standards to internal and external stakeholders.
• Build and maintain relationships with stop loss carriers to support case resolution and negotiation efforts.
• Clearly articulate Nirvana Health services, underwriting philosophy, and new initiatives to internal and external stakeholders.

Process Improvement & Strategic Support

• Lead or contribute to departmental projects and continuous improvement initiatives aimed at enhancing productivity, accuracy, and customer service.
• Identify and implement opportunities for automation and operational efficiency; influence the development of tools and resources.
• Support the use and optimization of underwriting tools, systems, and reporting platforms.
• Provide strategic input on stop loss placement, pricing, and product positioning.

Subject Matter Expertise

• Demonstrate deep knowledge of Nirvana Health product portfolio, underwriting philosophy, and market positioning.
• Support the development of proposals that align with client goals and organizational strategies.
• Analyze operational data and apply insights to financial modeling and fee development.
• Serve as a trusted resource for internal partners on underwriting and stop loss strategy.

Required Qualifications

• 5+ years of experience in underwriting, financial analysis, pricing methodologies, and/or funding arrangements.
• 2+ years of relevant medical insurance experience: brokers (producers), carriers, (TPA) third-party administrators, benefit analysis, underwriting, rating methodologies, or policy marketing, etc.
• Strong analytical, decision-making, and communication skills.
• Proficiency in Excel, Salesforce, Tableau, and/or VBA experience and Microsoft Office.
• Experience communicating with outside consultants or customers.

Education

• Bachelor's degree required or equivalent years of related experience.

Anticipated Weekly Hours

40

Type

Full time

Pay Range

$90,000.00 - $135,860.00