Senior Medical Underwriting Specialist

nirvanaHealth | RxAdvance; Southborough (MA); On-site; USD 140,000 - 210,000; Full time

Job summary

nirvanaHealth, under RxAdvance Corp., seeks an experienced actuary to build and validate the rating engine for U.S. commercial health insurance. You will specify math, create worked examples in Excel, and ensure the engine matches filings and regulations. This role partners with engineers to translate methodology into scalable platform logic.

The ideal candidate has 5+ years in medical underwriting, pricing for group health, and deep familiarity with ACA small-group rules and rate filings.

Qualifications

• Bachelor’s degree in accounting, mathematics, finance, or similar fields.
• At least 5 years of medical underwriting experience in a health plan or managed care setting.
• 5+ years pricing commercial group health.
• Experience building manual rate models: base claims development, trend, area and demographic factors, industry loads.
• Ability to explain why rating factors affect premiums and how leverage grows with trend.
• Operational ACA small-group knowledge and rate-filing literacy.
• Spreadsheet rigor and auditable worked examples.

Responsibilities

• Reverse-engineer carrier rate filings into precise, implementable factor specifications.
• Build member-level worked examples in Excel with traceable source tables and lookups.
• Own methodology for the manual rating pipeline: base claims, trend, area factors, demographic factors, industry loads, and cost-share waterfall.
• Keep ACA small-group pipeline legally exact: single risk pool, age curves, family build-up, prohibited factors enforced.
• Specify experience rating end to end: credibility formulas, pooling, shock adjustment, completion factors.
• Review engine output against worked examples with the engineering team and resolve discrepancies.
• Translate carriers’ methodologies into platform abstractions and shape pricing for level-funded products.

Skills

Actuarial analysis

Underwriting experience

Excel modeling

Payer industry knowledge

Communication

Education

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

Tools

Spreadsheet rigor

Job description

nirvanaHealth, under RxAdvance Corp., seeks an experienced actuary to build and validate the rating engine for U.S. commercial health insurance. You will specify math, create worked examples in Excel, and ensure the engine matches filings and regulations. This role partners with engineers to translate methodology into scalable platform logic.

The ideal candidate has 5+ years in medical underwriting, pricing for group health, and deep familiarity with ACA small-group rules and rate filings.