Work in Washington Veterans Jobs

Job Information

Cambia Health Solutions Pharmacy Underwriter Lead in Ahtanum, Washington

Pharmacy Underwriter LeadThe position can be anywhere in the states with a preference for candidates in our four Cambia states - OR, WA, ID, or UTThe Pharmacy Underwriter Lead will support both new and renewal case specific ASC (self-insured) Pharmacy Benefit Management (PBM) pricing. The Pharmacy Underwriter will be responsible for quoting and rating proposals and renewal projections. Acts as a subject matter expert providing guidance to the Underwriting team for Pharmacy rating.Responsibilities:* Develop prospective and renewal pharmacy rates and terms (AWP discounts, rebates, and administrative fees) for group accounts in accordance with corporate and underwriting guidelines.*Collaborate with both internal and external colleagues in developing client-specific pharmacy pricing strategies.* Work with proposal unit to ensure responses, including pertinent definitions and caveats, to all RFPs are complete and accurate.* Support internal underwriting staff regarding pharmacy pricing questions.* Effectively communicate pharmacy pricing decisions to other departments when necessary.* Assist in the training process and mentoring of the Underwriting team related to pharmacy pricing.* Analyze data from the PBM underwriting staff to produce market appropriate proposals.* Contribute to the development of new pharmacy pricing formulas, methodologies, and guidelines.* Prepare pharmacy reporting to provide for book of business insights.* Assist with testing new pricing, underwriting and front-end systems as needed.* Ensure the proper administration of underwriting and legislative guidelines for new and renewing groups.* Achieve overall corporate financial goals by applying appropriate pharmacy pricing methodologies.* Build winning financial offers that balance internal profitability and ensure competitiveness in the market.Additional responsibilities for the Lead level:* Serves as primary liaison with external PBM underwriting staff.* Serve as the primary point of contact and subject matter expert for the ASC pharmacy line of business in corporate and divisional underwriting project planning.* Represent Underwriting in Cambia workgroups and strategy sessions and serve as department representative where applicable.* Act as the liaison between various internal departments to ensure open communication and bring transparency to pharmacy underwriting functions.* Provide leadership in the improvement of pharmacy underwriting work processes as needed.* Consult with Legal and Pharmacy to ensure contractual terms, caveats, and other pertinent information is accurate and supports the offer as underwritten.* Partner with Legal to ensure final contract reflects the accepted financial offer.* Coordinate and support training as needed for pharmacy policies, procedures, and systems.* Support the development of and consistent administration of policies and procedures for ASC pharmacy pricing.Minimum Requirements:* Prior experience with a major Pharmacy Benefit Manager, Health Plan, Pharmacy Brokerage or Consulting Practice.*Extensive knowledge of the health insurance and PBM industry and pricing practices.* Demonstrated detailed knowledge of PBM pricing and concepts, including complex terms and conditions and their impact on the overall offer position.* Successfully demonstrated skills and experience in underwriting and pricing of various funding options and products.* Ability to build and maintain positive internal and external customer interactions.* Demonstrated attainment of a high level of independent, consistent performance.* Ability to organize, plan, prioritize and complete complex assignments with little or no supervision.* Demonstrated high l