Director, Networks and Underwriting

Description

TrueScripts Management Services is a pharmacist-founded, fully transparent Prescription Benefit Manager that has been revolutionizing the PBM industry since 2014. Our mission is to build lasting relationships by providing prescription benefit expertise at a personal and customized level to ensure optimum value at the lowest possible cost. We are committed to lowering prescription drug spending, achieving clinically effective outcomes, and always delivering Amazing Care.Did we mention Amazing Care? Good! Because this is so much more than just our tagline. It is the foundation upon which our business was built. We believe that Amazing Care starts from within, and our culture is reflective of this philosophy. Our team members enjoy:

• A wide range of health insurance options including medical, dental and vision
• A strong salary and bonus program
• A robust 401k and company match
• Truescripts is transitioning to an ESOP, a team member owned company! Each year team members are allocated shares of stock through our ESOP, a Qualified Retirement plan!
• A flexible work environment
• A 5-star wellness program including financial incentives, chiropractic and massage services, and fitness stipends
• Dream Manager Program (yes, it’s a real thing!)
• A cohesive, family-based culture
• Charitable contributions and volunteer time

Position Overview:

 The Director of Networks & Underwriting is responsible for leading TrueScripts’ pharmacy network strategy, network performance, and underwriting capabilities to ensure the organization delivers competitive, sustainable, and financially sound pharmacy benefit solutions. This role combines strategic leadership of pharmacy network relationships and performance with oversight of underwriting, pricing, financial modeling, guarantees, and risk analysis. The Director partners closely with Sales, Client Services, Finance, Analytics, Clinical, Operations, and Executive Leadership to develop competitive proposals and ensure contracted economics align with TrueScripts’ financial objectives and client commitments. The ideal candidate brings deep knowledge of PBM pharmacy networks, pharmacy reimbursement, MAC and ingredient cost methodologies, manufacturer economics, guarantees, pricing models, and PBM underwriting. This leader must be highly analytical and commercially minded, with the ability to translate complex data into clear recommendations and business decisions. 

Key Responsibilities:

Network Strategy & Leadership 

• Lead network strategy, performance management, contracting strategy, and network optimization. 
• Evaluate network options and determine the appropriate network structure for different client populations and market segments. 
• Establish network performance objectives and monitor network economics, access, competitiveness, and client impact. 
• Partner with Network leadership to ensure pharmacy contracting strategies support TrueScripts’ overall financial and client objectives. 
• Analyze pharmacy reimbursement trends, market dynamics, competitive positioning, and changes in pharmacy economics. 
• Identify opportunities to improve network value while maintaining appropriate pharmacy access and client satisfaction. 
• Oversee network performance against contractual requirements, guarantees, and financial expectations. 
• Develop strategies for managing network disruption, pharmacy access concerns, and market changes. 

Underwriting & Pricing 

• Lead the development and ongoing enhancement of TrueScripts’ PBM underwriting methodology. 
• Oversee financial modeling for new business, renewals, and existing client opportunities. 
• Establish appropriate assumptions for pharmacy utilization, drug mix, reimbursement, discounts, rebates, dispensing fees, trends, and other financial variables. 
• Evaluate financial risk and margin opportunity associated with prospective and existing business. 
• Develop pricing recommendations that balance competitiveness, client value, and TrueScripts’ financial objectives. 
• Review and approve underwriting assumptions and financial models for accuracy and reasonableness. 
• Establish appropriate risk thresholds, pricing guidelines, and escalation requirements. 
• Partner with Sales and Finance to evaluate opportunities that fall outside established underwriting parameters. 
• Ensure pricing models appropriately reflect network economics and expected claims experience. 
• Continuously refine underwriting models based on actual performance and emerging market trends. 

Guarantees & Financial Performance 

• Oversee the development and management of contractual guarantees related to network discounts, ingredient cost, rebates, trend, pricing, and other PBM financial commitments. 
• Establish processes for monitoring performance against guarantees throughout the client lifecycle. 
• Partner with Finance, Analytics, and Client Services to identify potential guarantee risk before it becomes a client or financial issue. 
• Analyze actual versus expected performance and identify drivers of variance. 
• Recommend corrective actions when performance is trending outside expectations. 
• Support contract negotiations by providing financial analysis and risk assessments. 

New Business & Renewals 

• Serve as a senior subject matter expert supporting new business and renewal opportunities. 
• Partner with Sales and Client Services throughout the RFP and proposal process. 
• Review RFP requirements and identify financial, contractual, and network risks. 
• Develop or oversee pricing models and financial projections. 
• Evaluate the profitability and strategic value of prospective business. 
• Provide executive leadership with clear recommendations regarding pricing, risk, and deal structure. 
• Support negotiations involving network economics, guarantees, pricing, and financial commitments. 
• Ensure proposals are financially sound and operationally achievable before commitments are made. 

Network Contracting & Pharmacy Economics 

• Provide strategic direction regarding pharmacy reimbursement and contracting approaches. 
• Evaluate pharmacy acquisition costs, reimbursement methodologies, MAC pricing, ingredient cost structures, dispensing fees, and other network economics. 
• Monitor pharmacy market trends and competitive network strategies. 
• Evaluate opportunities for network optimization and improved purchasing economics. 
• Partner with Network leadership to assess contracting opportunities and potential financial impact. 
• Ensure network decisions are evaluated not only for access and competitiveness but also for long-term financial sustainability. 

Analytics & Performance Management 

• Partner with Analytics and Finance to develop dashboards and reporting that provide visibility into network and underwriting performance. 
• Establish key performance indicators for network economics, pricing accuracy, guarantee performance, profitability, and forecast accuracy. 
• Analyze actual performance against underwriting assumptions. 
• Identify trends, anomalies, and opportunities requiring leadership attention. 
• Develop executive-level reporting that translates complex financial and network information into actionable recommendations. 
• Use data to continuously improve underwriting assumptions and network strategy. 

Cross-Functional Leadership 

• Partner with Finance to ensure alignment between underwriting assumptions, financial forecasts, and actual performance. 
• Partner with Sales to ensure pricing strategies support competitive growth. 
• Partner with Client Services to address client-specific financial and network issues. 
• Partner with Clinical to understand utilization trends and clinical program impacts on financial performance. 
• Partner with Operations to ensure financial commitments are operationally achievable. 
• Partner with Data & Analytics to improve modeling capabilities, reporting, and predictive analysis. 
• Provide executive leadership with recommendations regarding network strategy, pricing, risk, and profitability. 

Leadership Responsibilities 

• Lead, develop, and coach Network and Underwriting team members. 
• Establish clear goals, performance expectations, and accountability. 
• Build a high-performing team with strong PBM, analytical, financial, and commercial capabilities. 
• Develop succession plans and ensure critical network and underwriting knowledge is not concentrated in single points of failure. 
• Establish standardized processes and documentation to improve scalability and reduce organizational risk. 
• Foster a culture of data-driven decision-making, accountability, collaboration, and continuous improvement. 

Requirements

• Bachelor’s degree in Accounting, Finance, Business, Healthcare Administration, Compliance, or related degree in Business, Finance, Economics, Healthcare Administration, Pharmacy, or related field. 
• 7+ years of progressive experience in PBM, pharmacy benefits, healthcare, underwriting, network management, pricing, or related areas. 
• Demonstrated experience with PBM financial modeling and underwriting. 
• Strong understanding of pharmacy network economics and reimbursement methodologies. 
• Experience with PBM pricing, guarantees, rebates, discounts, and financial commitments. 
• Strong analytical and financial modeling skills. 
• Demonstrated experience leading cross-functional initiatives and influencing executive-level decisions. 
• Strong understanding of pharmacy claims and utilization data. 
• Excellent communication, negotiation, and presentation skills. 

Working Conditions:

• Primarily remote position with occasional travel to the TrueScripts office in Washington, Indiana, for meetings, team events, training, and cultural activities as needed
• Less than 10% travel required