Senior Underwriting Analyst

EmpiRx Health, LLC.; Montvale (NJ); Hybrid; USD 120,000 - 180,000; Full time

Benefits offered by this job

Health Insurance

401(k) program

Paid Time Off

Job summary

EmpiRx Health in Montvale, NJ is hiring a Senior Underwriter, Pharmacy Benefits. The role leads financial underwriting for complex RFPs, renewals, and BAFOs, translating pharmacy data into clear financial recommendations and protecting client value and company margin.

The position requires strong Excel modeling, pricing design, and collaboration across commercial, clinical, financial, contracting, and implementation teams in a hybrid work setting.

Qualifications

• Bachelor's degree or equivalent with 5+ years in PBM/healthcare or related financial underwriting
• Hands-on experience with PBM or health-plan claims and pricing fundamentals
• Strong Excel skills and ability to build and explain financial models
• Experience with guarantee design, reconciliation, and client P&L decisions
• Able to present assumptions and recommendations to leadership

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, rebates, and margins.
• Validate inputs, reconcile totals, and document assumptions.
• Build and explain base, upside, and downside scenarios and translate results into recommendations.
• Design and reconcile pricing guarantees, including true-ups and exclusions.
• Integrate claims economics, rebates, and fees into client P&L and margin analysis.
• Lead cross-functional collaboration with Sales, Clinical, Contracting, and Implementation.

Skills

Excel advanced

Financial modeling

Data analysis

Communication

Education

Bachelor's degree in Finance/Economics/Math

Master's degree preferred

Tools

Tableau

Salesforce

Financial modeling tools

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Full Time US

2 days ago Requisition ID: 1290

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.

Key Responsibilities

Underwriting Strategy & PBM Financial Modeling

• 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.

RFP Ownership & Cross-Functional Leadership

• 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.

Tools & Analytics

• Advanced Microsoft Excel and financial-modeling capability, including complex formulas, data validation, scenario analysis, and audit-ready workpapers.
• Ability to use Tableau, Domo, or comparable analytics tools to communicate insights; automation or model-product experience is a plus.
• Experience using Salesforce or a comparable CRM or workflow platform for deal tracking and coordination.
• Proficiency with underwriting or pricing models and large claims or financial datasets.

Required Qualifications & Experience

• 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.

Preferred Qualifications & Experience

• 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.

Work Environment

Remote or hybrid on-site in Montvale, NJ.

Subject to program eligibility, this position qualifies for a robust suite of benefits including: Paid Time Off, a 401(k) program, Health Insurance including Dental & Vision coverage, Student Loan Reimbursement, Health Savings Account, and an Employee Assistance Program.

EmpiRx Health is an Equal Opportunity Employer

At EmpiRx Health, we wholeheartedly embrace the power of diversity and the magic of inclusion. The kaleidoscope of unique perspectives, backgrounds, and talents fuels our innovation and sets us apart. We're on a mission to build a team as diverse as the world we serve, where everyone is welcome and celebrated. We're not just breaking down barriers; we're actively erasing them to create an environment where opportunity knows no bounds. In unity, we find our strength and invite individuals from all walks of life to join us in our exhilarating journey to shape a brighter, more inclusive future together.

Note: This job description is a general outline of responsibilities and qualifications for the role. Additional duties may be assigned, and the position may evolve to meet the organization's needs.