Senior Manager, Underwriting

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Caremark is recruiting for an exciting opportunity to join it’s CVS Health’s leadership team as a Senior Manager, Pharmacy Benefit Management (PBM) Underwriting, Analysis and Strategy. In this role, you will lead a critical segment supporting a strategic PBM client division of CVS with responsibility for identifying and executing on opportunities to optimize client engagement and profitability by developing pricing offers that support client retention and growth.  Daily activities include monitoring financial performance of the division, providing consultative information and recommendations in plan design, distribution channel, underwriting new pharmacy contracts and leading opportunities to increase revenue and profit margins.

You'll make an impact by:

• Develop comprehensive proposal strategies for Pharmacy RFPs
• Developing and maintaining a deep understanding of PBM financial levers within Commercial, Medicaid, Medicare Part D, and Public Exchange lines of business.
• Conduct market and competitive analyses to understand industry trends, client needs, and competitor offerings.
• Client relationship management by engaging with the client to understand their specific needs and concerns, building a strong, trust-based relationship and positions the company as a preferred partner.
• Leading end to end financial optimization and pricing activities across Caremark’s PBM Health Plan clients ensuring timeliness, accuracy, and consultative value of analytic output.
• Performance metrics and reporting by establishing and monitoring key performance indicators (KPIs) related to RFP success rates, turnaround times, and client satisfaction. Provide regular reports and insights to senior management to inform strategic decision-making and drive continuous improvement in the underwriting process.
• Communicating with key internal partners such as Sales and Account Management, Trade, Networks, IT and Product Development. The incumbent will work directly with the external clients to develop a deep understanding of their business and goals to assist with creating and supporting products and solutions that align with their strategy.
• Developing and maintaining effective working relationships with key internal partners across the enterprise, including executive-level decision makers.
• Guiding pricing consultation and strategy in an evolving regulatory environment to ensure compliance.
• Exercising sound business judgment to achieve proper balance between client retention and CVS Caremark profitability.  
• Acquiring and maintaining leading-edge knowledge of PBM plan management strategies and solutions.
• Participating in external client and consultant meetings.
• Providing domain expertise across the full spectrum of financially related efforts aimed at retaining and growing the revenue and profitability on behalf of CVS and the client, including leading client renewals, conducting market check pricing, and identifying and communicating opportunities to increase revenue and profit margins across areas such as plan design, channel, clinical, and other solutions.
• Deep understanding of different lines of business (ex. fully insured, ASO, Medicaid, Medicare, Exchanges) to provide relevant recommendations and to influence client adoption of custom and standard solutions.
• Cultivating and maintaining relationships with key internal partners within the Division as well as identifying and communicating opportunities to increase revenue and margin at a client-level as well as use data to identify and position opportunities to drive value.
• Maintaining overall accountability for implementing and overseeing processes
• Collaborating with internal partners to develop products and services that bring to bear CVS Caremark’s enterprise assets, differentiate the firm from its retail/PBM competitors, and attract and retain health plan lives.
• Working independently in a fast-paced environment and handling tight deadlines with appropriate level of delegation to team members.
• Supporting CVS Health in attracting, retaining, and engaging a diverse and inclusive consumer-centric workforce that delivers on our purpose and reflects the communities in which we work, live, and serve.

Required Qualifications

The candidate will have a strong work ethic, be a self-starter, and be able to be highly productive in a dynamic, collaborative environment. This position offers broad exposure to all aspects of the company’s business, as well as significant interaction with all the business leaders. The candidate will be expected to have the following key attributes:

• 7+ years of prior underwriting or financial analysis experience
• 5+ years of professional experience, preferably within a PBM or health plan.

Preferred Qualifications

• Understanding of quality measures such as HEDIS and Star ratings and their importance to customers.
• Broad knowledge of the overall enterprise infrastructure, including operational systems and data warehouses.
• Experience with health plans that are highly custom in their approach to pharmacy benefit services – complex pricing arrangements, custom formularies, clinical programs, channel solutions, and integrated benefit designs.
• Requires knowledge of PBM profit levers, underwriting and financial models.
• Understanding of healthcare and pharmacy claims data and common tools used to manipulate data.
• Exceptional communication skills across the full spectrum of formal and informal channels and to multiple audiences, including external clients, consultants, internal partners, and executive leadership. Proven ability to educate and influence external customers and internal partners.
• Ability to manage and deliver on client expectations within assigned book of business.
• Skilled at collaborating and working across a complex matrixed organization. 
• Experience working with varying levels of client contacts, including executive leadership, Chief Medical Officers, pharmacy department leadership, provider networks, actuaries, financial analysts, and consultants.

Education

Bachelor’s Degree is required.  Advanced degree in a relevant field, such as an MBA a plus.

Pay Range

The typical pay range for this role is:

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.  This position also includes an award target in the company’s equity award program. 
 

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.

• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.