Director Underwriting & Pricing

Location Address

9521 San Mateo NE Albuquerque, NM

Presbyterian Health Plan (PHP) seeks a strategic and analytically driven leader to serve as Director, Underwriting & Pricing. This highly visible leadership role is responsible for developing and executing underwriting, pricing, and rating strategies that support growth, profitability, regulatory compliance, and long-term financial sustainability across the Health Plan.

Reporting to senior health plan leadership, this executive oversees underwriting and pricing for commercial large group, level-funded, and Administrative Services Only (ASO) products while providing enterprise leadership for ACA Individual and Small Group rate development and implementation. The Director also leads reinsurance strategy and negotiations across all lines of business and serves as a key partner to Sales, Actuarial, Finance, Product, and Market leadership.

This role is ideal for a leader who combines strong technical underwriting expertise with strategic business acumen, exceptional communication skills, and a proven ability to influence business outcomes in a complex healthcare environment.

Remote:
Open to applicants in the United States, excluding CA, IL, ND, NY, OH, WA, and WY.

Hybrid:
For individuals within 60 miles of Albuquerque, in-office presence is required Tuesday through Thursday.

• Develop and execute underwriting and pricing strategies for Commercial Large Group, Level-Funded, and ASO business segments.
• Partner with executive leadership to support organizational growth, profitability, and market competitiveness.
• Contribute to the development and execution of commercial market and sales strategies.
• Evaluate emerging market trends and recommend pricing actions to support business objectives.

• Monitor Medical Loss Ratio (MLR) performance across commercial and level-funded products.
• Identify emerging financial trends and implement corrective pricing or underwriting actions as needed.
• Develop periodic revenue forecasts to support organizational budgeting and provider contracting activities.
• Ensure pricing assumptions appropriately reflect benefit design, administrative expenses, commissions, and risk profiles.

• Lead annual ACA Individual and Small Group rate development and implementation processes.
• Ensure rate development methodologies comply with all applicable regulatory requirements.
• Oversee successful implementation and loading of approved rates into operational systems.
• Ensure timely development and distribution of annual renewal communications.

• Lead negotiation and procurement of reinsurance agreements across all lines of business.
• Evaluate market conditions and reinsurance opportunities to optimize financial performance and risk protection.
• Partner with Finance and Actuarial leadership to assess and manage enterprise risk exposure.

• Ensure timely filing of underwriting guidelines, rating methodologies, and pricing parameters.
• Lead annual Federal Employees Health Benefits Program (FEHBP) rate proposal and reconciliation processes.
• Support regulatory audits and inquiries, including Office of Inspector General (OIG) reviews.
• Maintain compliance with federal, state, and industry underwriting requirements.

• Lead, mentor, and develop a high-performing underwriting team.
• Establish clear performance expectations, accountability measures, and professional development opportunities.
• Foster a culture of collaboration, customer service, analytical rigor, and continuous improvement.

• Serve as a trusted advisor to Sales, Marketing, brokers, and consultants on underwriting and pricing matters.
• Evaluate non-standard proposals and exception requests to ensure financially viable decisions.
• Effectively communicate complex financial and underwriting concepts to executive, internal, and external stakeholders.

Within the first 12-24 months, the Director will:

• Strengthen underwriting and pricing strategies to support profitable membership growth.
• Ensure ACA, Large Group, and Level-Funded products achieve targeted financial performance.
• Enhance forecasting accuracy and underwriting performance analytics.
• Maintain full compliance with regulatory rate filing requirements and audit standards.
• Successfully negotiate reinsurance arrangements that balance risk…