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We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Position Summary
As the Manager, Medical Underwriting, you will use your clinical expertise to support Aetna’s underwriting decisions and strategic goals by evaluating and managing medical risk. In this role, you’ll partner closely with underwriting and account teams to assess new and renewal large group cases, review high‑cost claims, and project future medical costs based on diagnosis and prognosis.
You’ll serve as a clinical consultant to Medical Underwriters, providing guidance on cases and appeals, approving or denying requests, and ensuring claim ranges are clinically appropriate. You’ll also conduct clinical audits and share educational feedback to support sound underwriting decisions with meaningful benefit implications. In addition, you will participate in project work groups including process improvement initiatives.
This is a hybrid role if located in or near the Hartford area or remote if located elsewhere. .
Required Qualifications
Registered Nurse, highly technical, analytical clinician with sound understanding of underwriting risk assumptions.
Preferred Qualifications
3 - 5 years of experience in medical underwriting and risk assessment.
Education
Active Registered Nurse certification.
This role does not support sponsorship
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$66,330.00 - $145,860.00This 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. Â The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. Â This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.Â
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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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
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