• Provide guidance and consultation to Sales and Client Management teams on pricing and stop-loss strategies. • Prepare and deliver moderately complex new business quotes, existing business renewals, and/or accountings, while meeting established departmental TAT goals. • Prepare financial projections on prospects, utilizing financial models in Microsoft Excel and Salesforce. • Market and place stop loss policies, negotiating terms based upon claims data, strategy, relationships, and cost avoidance/reduction efforts. • Work with leaders from key functional areas to understand potential impacts for custom requests. • Manage and interpret operational data, and apply to fee development and financial analysis. • Present to internal/external customers, constituents, and business partners. • Display a clear understanding of Meritain products and services, along with strong business and systems knowledge. • Review work for accuracy and recommend pricing and/or accounting alternatives based on financial analysis, underwriting principals, and business strategy. • Develop and participate in presentation to existing and prospective customers, business partners, and internal business areas. • Collaborate with leadership in Sales to determine the appropriate product mix to issue on proposals that target reducing total cost of care for the plan sponsor. • Independently assist sales and client management personnel in explaining rates/fees and communication of underwriting and stop loss policies. • Establish and maintain a positive and productive relationship with sales, client management, our stop loss panel, and internal partners.

• Develop and implement underwriting workflows, SOPs, SLAs, checklists, and QC measures to ensure high-quality and efficient loan underwriting. • Regularly access and enhance our Underwriting Systems to ensure smooth file flow, high quality, regulatory compliance and efficiency. • Oversee day-to-day operations with fulfillment partners, ensuring consistent loan delivery. • Define and monitor productivity standards and performance goals and ensure that they are met on a monthly, quarterly and annual basis. • Conducting 2nd level reviews, handling exceptions, and managing escalations to ensure quality control. • Act as a subject matter expert, aiding decision-making and driving product improvement. • Working closely with internal teams, partners, and engineering to drive product improvements and optimize the fulfillment infrastructure. • Provide technical and guideline training, recommend areas of improvement, and conduct ongoing training as needed. • Maintain a comprehensive understanding of mortgage origination and regulations to ensure compliance.

In a few words… Abarca is igniting a revolution in healthcare. We built our company on the belief that with smarter technology we are redefining pharmacy benefits, but this is just the beginning… Our Drug Value Strategy team goes from managing day-to-day pharmacy network operations, developing standard reporting, to crafting pricing and underwriting strategies. Our Drug Pricing & Underwriting Strategy folks participate in client negotiations to establish rebates with key industry players while also creating attractive pricing strategies and formulary recommendations for potential clients. As our Senior Underwriting & Pricing Analyst you will be responsible for underwriting and analysis forecasts to help Abarca effectively manage risk when pricing prospective clients while providing an attractive overall cost of goods. This is an analytical role that will have a direct impact on helping clients reduce their spending on prescription drugs. You should be curious, data oriented, and a self-starter. You will have exposure to many areas within Abarca and will have a strong understanding of all drivers of pharmacy cost. This role will interface closely with our sales and finance teams. The fundamentals for the job… Perform underwriting analysis and risk assessment for new and/or renewal of large group contracts. Collaborate with field sales, clients, and internal management to review complex RFP's and make strategic recommendations that best fit the customer's needs. Develop and maintain complex financial models, integrating multiple data sources, to accurately model pricing scenario impact for new and existing business. Develop a keen understanding of cost drivers of the pharmacy benefit management business and forecast fixed and variable costs for prospects. Understand key rebate drivers and utilization changes based on industry trends to complete rebate forecasts. Identify outliers in prospective client claim data to ensure accuracy of pricing analyses. Forecast Abarca’s operating costs, ancillary fee revenues and clinical program return of investments so that Abarca can holistically understand revenues streams and customer savings opportunities for prospective and existing clients. Interface with internal and external business partners to develop and integrate additional product offerings. Utilize market intelligence to analyze competitive position on a case specific basis and develop financial comparisons. Negotiate and fully explain rate development, pricing components, and application of underwriting policies to present proposal recommendations and financial outcomes to internal and external constituents. Keep meticulous documentation, tracking and recording our pricing strategy and modeling approach for each prospect. Produce timely and accurate customer specific documents, deliverables, and account related information. What we expect of you The bold requirements… Physical requirements… Must be able to access and navigate each department at the organization’s facilities. Sedentary work that primarily involves sitting/standing. At Abarca we value and celebrate diversity. Diversity, equity, inclusion, and belonging are guiding principles of Abarca and ensure Abarca’s workforce reflects the communities it serves.  We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. Abarca Health LLC is an equal employment opportunity employer and participates in E-Verify.  “Applicant must be a United States’ citizen. Abarca Health LLC does not sponsor employment visas at this time” The above description is not intended to limit the scope of the job or to exclude other duties not mentioned. It is not a final set of specifications for the position. It’s simply meant to give readers an idea of what the role entails. #LI-NO1 #LI-REMOTE

We are currently hiring for a Stop Loss Registered Nurse to join BlueCross BlueShield of South Carolina. In this role as a Stop Loss Registered Nurse, you will evaluate and manage catastrophic episodes of illness for underwriting and claims. Ensures that the insured is receiving the best medical care, but in the most cost effective manner. Location: This position is full-time (40 hours/week) Monday-Friday, from 8:00am – 4:30pm EST, and will be fully remote. Facilitates cost estimates to the underwriters for new and renewal stop loss business. Consults with the underwriters on catastrophic episodes of illness. Provides case management oversight of managed care between the TPA and us. Review potential claim notices and excess claims received to determine setting reserves. Reviews potential claims notices from TPAs. Researches as necessary to evaluate cost containment and intervenes with the TPA.