Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.
We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration - because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.
The Pharmacy Underwriter Consultant has primary responsibility for managing financial analysis, risk assessment, and underwriting consult of pharmacy Request for Proposals (RFPs) for Medica self-insured employer groups. This includes consulting with internal partners to devise successful strategies to provide competitive pharmacy price proposals to retain and win new employer group lives. The role will interact with external pharmacy partners to support Medica pharmacy proposals including negotiating with clients, brokers and consultants on pharmacy guarantees and contracts.
Key Accountabilities
- Pharmacy Underwriting
- Partners internally and with external stakeholders to identify key characteristics of commercial clients to develop alternative pharmacy pricing strategies; provides alternative pricing models as applicable in RFPs
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Leads complex pharmacy RFPs for key/strategic cases
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Manages financial analysis, risk assessment, and pricing for new business and renewals engaged in alternative pharmacy pricing models
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Communicates and explains rationale of pricing recommendations for pharmacy RFPs to Medica's Commercial sales, Underwriting, and Pharmacy teams
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Runs client level rebate projections in support of underwriting for pharmacy RFPs
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Works with RFP and Underwriting team to complete pharmacy RFP questionnaires
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Interacts with external brokers, consultants, and clients in support of pharmacy RFP's and contracting
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Serves as a pharmacy pricing subject matter expert to Medica's Underwriting Team
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Maintains awareness of competitive Commercial pharmacy pricing models and strategies occurring in the marketplace
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Quality assurance of Advanced Pricing Management group setup
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Review annual client pharmacy guarantee reconciliations for reasonableness, accuracy, and results
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Track competitive intel and consultant playbooks for Underwriting
- Training and Development
- Participate in departmental training forums, including providing training to internal staff (pharmacy pricing training to Sales and Underwriting, new staff training, as needed)
- Mentor new underwriters in support of pharmacy pricing, providing consultation to less experienced staff as needed
- Develop and deliver training materials related to pharmacy pricing strategies and underwriting processes to internal partners
- Additional Responsibilities
- Supports Underwriting and Pharmacy team as needed and as requested by manager
- Participates in committee work as assigned by manager
- Actively participates in internal and external commercial pharmacy, client, and underwriting meetings necessary to support key accountabilities
Required Qualifications
- Bachelor's degree or equivalent experience in a related field
- 5+ years of work experience beyond degree
Preferred Qualifications
- Complete working knowledge and skill with ability to be fully proficient in professional field
- 5 years+ of underwriting/pricing experience; strongly preferred within the PBM industry or pharmacy underwriting at a Health Plan
- Pharmacy pricing and RFP experience
- Ability to negotiate, influence, and persuade
- Ability to multi-task between cases and projects
- Strong knowledge of Microsoft Excel
- Exceptional written and interpersonal communication skills; presentation skills
- Knowledge of SalesForce
- Strong financial acumen and analytical skills, with the ability to translate insights into business impacts and actionable next steps
- Ability to analyze and use qualitative and quantitative data and incorporates understanding into decision criteria
- Possess an in depth understanding of the various Legal and Compliance implications within PBM in order to ensure risk mitigation
- Ability to utilize relationship development skills, organizational skills, diplomacy, assertiveness and focus to collaboratively drive for results in a cross-functional environment
- Be an advocate for best practices and continues learning
This position is an Office role, which requires an employee to work onsite, on average, 3 days per week. We are open to candidates located near one of the following office locations: Minnetonka MN, Madison WI, Omaha NE, and St. Louis MO.
The full salary grade for this position is $88,800 - $152,300. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $88,800 - $133,245. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to base compensation, this position may be eligible for incentive plan compensation in addition to base salary. Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.
The compensation and benefits information is provided as of the date of this posting. Medica's compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.
Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.
We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.
