Location Address:
9521 San Mateo NE Albuquerque, NM 87113-2237Summary:
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.
Work Arrangement:
• 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.
Job Description:
Strategic Underwriting & Pricing Leadership
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.
Financial Performance & Risk Management
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.
ACA Individual & Small Group Pricing
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.
Reinsurance Strategy
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.
Regulatory & Compliance Oversight
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.
Leadership & Talent Development
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.
Stakeholder Engagement
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.
Success Measures
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 protection and economic value.
Develop and retain a high-performing underwriting team capable of supporting strategic growth objectives.
Additional Job Description:
Required: Bachelor's degree in Business, Finance, Economics, Mathematics, Healthcare Administration, or a related field.
Preferred: Master's degree (MBA, MHA, or related discipline).
Benefits
Benefits are effective day-one (for .45 FTE and above) and include:
- Competitive salaries
- Full medical, dental and vision insurance
- Flexible spending accounts (FSAs)
- Free wellness programs
- Paid time off (PTO)
- Retirement plans, including matching employer contributions
- Continuing education and career development opportunities
- Life insurance and short/long term disability programs
About Us
Presbyterian Healthcare Services is a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, it is the state's largest private employer with approximately 11,000 employees.
Presbyterian's story is really the story of the remarkable people who have chosen to work here. Starting with Reverend Cooper who began our journey in 1908, the hard work of thousands of physicians, employees, board members, and other volunteers brought Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system, serving more than 700,000 New Mexicans.
We are part of New Mexico's history - and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come.
About New Mexico
New Mexico's unique blend of Spanish, Mexican and Native American influences contribute to a culturally rich lifestyle. Add in Albuquerque's International Balloon Fiesta, Los Alamos' nuclear scientists, Roswell's visitors from outer space, and Santa Fe's artists, and you get an eclectic mix of people, places and experiences that make this state great.
Cities in New Mexico are continually ranked among the nation's best places to work and live by Forbes magazine, Kiplinger's Personal Finance, and other corporate and government relocation managers like Worldwide ERC.
New Mexico offers endless recreational opportunities to explore, and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it's all available among our beautiful wonders of the west.
AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.
Skills Required
- Bachelor's degree in Business, Finance, Economics, Mathematics, Healthcare Administration, or related field
- Master's degree (MBA, MHA, or related discipline)
- Proven experience leading underwriting and pricing for Commercial Large Group, level-funded, and ASO products
- Experience leading ACA Individual and Small Group rate development and regulatory filings
- Experience developing and implementing reinsurance strategy, negotiation, and procurement
- Demonstrated ability to monitor and manage Medical Loss Ratio (MLR) and implement corrective pricing actions
- Experience with revenue forecasting to support budgeting and provider contracting
- Knowledge of federal/state underwriting regulations and experience supporting regulatory audits (including FEHBP and OIG reviews)
- Proven leadership, mentoring, and talent development experience for underwriting teams
- Strong communication skills to present complex financial and underwriting concepts to executive and external stakeholders
What We Do
Presbyterian Healthcare Services is a locally owned, statewide, not-for-profit healthcare system in New Mexico. Founded in 1908, it operates nine hospitals, a medical group, and a health plan. The organization is dedicated to improving access to healthcare, behavioral health, and community support services, offering a wide range of specialties including primary care, cancer care, and heart and vascular care to improve the well-being of New Mexico residents.
