Director of Underwriting

About the role

The Director of Underwriting at Prescryptive leads complex underwriting for new and renewing pharmacy benefit business, working closely with Product, Pricing, Sales, and Finance to develop competitive and financially sound pricing. This role involves executing deal-level underwriting, managing multiple concurrent deals, and improving underwriting tools and processes.

Responsibilities

• Execute deal-level underwriting using historical claims, pharmacy network pricing, rebate commitments, and other deal-specific inputs.
• Partner with Product, Pricing, and Sales to optimize deal-specific pricing and identify savings opportunities.
• Manage multiple concurrent deals with shifting timelines while maintaining accuracy and underwriting rigor.
• Cook up rebate commitments with aggregators and lead underwriting for complex or non-traditional deal structures.
• Partner with Finance to evaluate deal-level risk and margin sufficiency.
• Analyze client and product profitability and bring forward insights on network economics, manufacturer contracting, specialty trends, and operational cost drivers.
• Improve underwriting tools, processes, and data quality through automation and AI-enabled capabilities while maintaining clear, defensible documentation.

Requirements

• 8+ years of underwriting experience, including substantial hands-on PBM/pharmacy benefit underwriting experience across new business and renewals.
• Recent hands-on experience independently building and evaluating pharmacy benefit pricing for self-funded employer groups.
• Deep understanding of PBM economics, including pharmacy network pricing, specialty utilization, rebates, guarantees, and margin drivers.
• Advanced Excel modeling skills, with the ability to independently build, interrogate, and modify complex underwriting models.
• Demonstrated commercial judgment, including the ability to evaluate risk, make pricing recommendations, and independently structure deals within defined guardrails.
• Able to manage multiple complex deals simultaneously in a fast-paced, high-accountability environment.
• Comfort using AI-enabled tools to improve modeling, analysis, and underwriting efficiency.

Qualifications

• Experience pricing mid-market and large employer groups.
• Exposure to underwriting governance frameworks.
• Experience in transparent or pass-through PBM environments.
• Experience improving underwriting automation or tooling.

Skills

• Commercial judgment
• Underwriting rigor
• Data quality improvement
• AI-enabled tools

Benefits

Prescryptive offers a flexible work schedule, including 12 paid holidays. We provide a 401(k) match plus 100% employer-provided medical, dental, and vision premiums. Additionally, we contribute to a Health Savings Account. Stock options are also available.

Pay

The projected annual salary range for this position is $175,000 - $225,000. Prescryptive's compensation decisions are based on relevant experience, internal equity, and location.

Schedule

Prescryptive offers a flexible work schedule.