Underwriting Manager - Pharmacy; Remote

Underwriting Manager - Pharmacy (Remote) at Care First Blue Cross Blue Shield

Provides insurance underwriting services by evaluating exceptions and appeals; reviewing reinsurance arrangements; auditing risk acceptability, new applications, declined files, and large limits; evaluating loss history, financial statements, and loss control surveys; assessing file documentation; analyzing product results; approving documents for state filings and marketing materials; and managing staff. Responsibilities also include overseeing pharmacy related underwriting functions, such as evaluating pharmacy benefit structures, reviewing high cost drug utilization and trends, assessing risk tied to specialty medications, and collaborating with Pharmacy Benefits Management (PBM) partners to ensure appropriate pricing, risk mitigation, and compliance.

Provides insurance underwriting services by evaluating exceptions and appeals; reviewing reinsurance arrangements; auditing risk acceptability, new applications, declined files, and large limits; evaluating loss history, financial statements, and loss control surveys; assessing file documentation; analyzing product results; approving documents for state filings and marketing materials; and managing staff. Responsibilities also include overseeing pharmacy related underwriting functions, such as evaluating pharmacy benefit structures, reviewing high cost drug utilization and trends, assessing risk tied to specialty medications, and collaborating with Pharmacy Benefits Management (PBM) partners to ensure appropriate pricing, risk mitigation, and compliance.

• Manages insurance underwriting employee outcomes by recruiting, selecting, orienting, training, assigning, scheduling, coaching, counseling, and disciplining employees; communicating job expectations; planning, monitoring, appraising, and reviewing job contributions; planning and reviewing compensation actions; enforcing policies and procedures.
• Achieves insurance underwriting operational objectives by contributing information and analysis to strategic plans and reviews; preparing and completing action plans; implementing production, productivity, quality, customer‑service, safety, security, and health standards; identifying and resolving problems; completing audits; identifying, developing, and implementing system improvements.
• Meets insurance underwriting financial objectives by estimating requirements; preparing an annual budget; scheduling expenditures; analyzing variances; initiating corrective actions.
• Completes insurance underwriting by evaluating exceptions and appeals; reviewing reinsurance arrangements; enforcing adherence to internal and external underwriting policies, procedures, guidelines, and regulations; auditing risk acceptability, new applications, declined files, and large limits; evaluating loss history, financial statements, and loss control surveys.
• Ensures legal compliance by auditing and enforcing guidelines, account contracts, and company business plan; verifying implementation of State‑mandated regulations and required forms and rates; approving documents for State filings, and marketing materials. Protects organization value by keeping information confidential; cautioning others regarding potential breaches.
• Resolves insurance problem escalations by evaluating file documentation; evaluating options; enforcing guidelines. Improves insurance product profitability by analyzing product results.
• Improves insurance underwriting job knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; benchmarking state‑of‑the‑art practices; participating in professional societies. Contributes to insurance underwriting and organization success by welcoming related, different, and new requests; helping others accomplish job results.

• Education Level: Bachelor's Degree OR, in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.
• Experience:

• 5 years progressive underwriting experience group health, medical, ancillary and/or…