Senior Medical Underwriting Nurse Manager

Optimyl Benefits provides accessible and streamlined healthcare plans for small employers, partnering closely with brokers to deliver competitive benefits solutions. The Senior Medical Underwriting Nurse Manager leads clinical risk strategy and underwriting excellence within the small group market. This role combines advanced nursing expertise with underwriting leadership to drive profitable risk selection, pricing strategy, and cross-functional collaboration.

Optimyl Benefits is seeking a Senior Medical Underwriting Nurse Manager to lead clinical risk strategy and underwriting performance within the small group health insurance market. Reporting to the VP of Small Group Underwriting, this role blends advanced clinical expertise with underwriting leadership to drive profitable risk selection, pricing integrity, and operational excellence.

Responsibilities:
- Develop and guide clinical underwriting guidelines to support effective risk management
- Partner with actuarial, sales, IT, and compliance teams to shape pricing and underwriting strategy
- Evaluate new business quotes and renewals to ensure eligibility, profitability, and policy compliance
- Analyze claims data, high-risk diagnoses, specialty pharmacy trends, and treatment plans
- Review and mentor underwriting analysts while maintaining production and timeliness standards
- Support departmental initiatives including fraud detection, compliance, and process improvements

Requirements:
- Registered Nurse (BSN required)
- Minimum 5 years of medical underwriting experience in stop loss, self-insured, or level-funded markets
- Advanced knowledge of high-risk diagnoses, specialty Rx, and claims analysis
- Strong analytical, communication, and leadership skills
- Experience calculating rates and evaluating financial arrangements
- Ability to adapt pricing within corporate risk management guidelines

Benefits:
- Competitive compensation package
- Comprehensive medical, dental, and vision coverage
- 401(k) with employer match
- Generous paid time off and company holidays

This role requires strategic clinical insight, underwriting expertise, and cross-functional leadership to support sustainable growth and risk management objectives.