Evaluador De Riesgo En Renovaciones Grupales

MCS Health; San Juan (PR); On-site; USD 60,000 - 90,000; Full time

Job summary

MCS Health in San Juan, Puerto Rico seeks an experienced professional to analyze utilization, claims, benefits, and demographics for fully insured group health and life accounts. You will support renewal pricing by preparing projections and evaluating plan designs against expected utilization.

The role requires at least two years of data analysis or underwriting experience, with a Bachelor’s in a quantitative field. The position is Exempt, on-site, within a collaborative actuarial team.

Qualifications

• Bachelor's degree in Business Administration with a quantitative concentration.
• Minimum of two years of experience in data analysis, health insurance underwriting, pricing, financial analysis, or fully insured group renewals.
• Experience with databases, reporting tools, and quantitative analysis is preferred.
• Experience within the health insurance industry is highly desirable.

Responsibilities

• Collects, validates, and analyzes claims, utilization, benefits, demographic, and financial data required for renewal evaluations.
• Extracts and maintains information from MCS Life systems to support pricing analyses, claim projections, and renewal evaluations.
• Applies methodologies and actuarial factors to assist in renewal rate analyses and claim cost projections.
• Assesses impact of plan design changes on utilization and costs.
• Reviews claim experience and trends to identify variances affecting account performance.
• Prepares claim projections and supporting analyses for review by senior team members.
• Collaborates with Account Executives by providing renewal analyses and responding to data requests.
• Maintains documentation and supports renewal activities per policies.

Skills

Data analysis

Health insurance underwriting

Pricing analysis

Financial analysis

Education

Bachelor’s degree in Business Administration (Quantitative focus)

Tools

Databases

Reporting tools

Job description

Regular

Exempt

GENERAL DESCRIPTION:

Responsible for collecting, validating, and analyzing utilization, claims, benefits, and demographic information for fully insured group health and life insurance accounts. Supports the renewal process by preparing claim projections, evaluating plan utilization trends, and providing data-driven analyses that contribute to pricing recommendations and business profitability.

ESSENTIAL FUNCTIONS:

• Collects, validates, and analyzes claims, utilization, benefits, demographic, and financial data required for the evaluation of fully insured group account renewals.
• Extracts and maintains information from MCS Life systems to support pricing analyses, claim projections, and renewal evaluations.
• Applies established methodologies and actuarial factors to assist in the development of renewal rate analyses and claim cost projections.
• Assesses the impact of plan design changes, including copayments, deductibles, and coinsurance, on expected utilization and claim costs.
• Reviews claim experience, utilization patterns, and historical renewal information to identify trends and variances affecting account performance.
• Prepares claim projections and supporting analyses for review and validation by senior team members or management.
• Collaborate with Account Executives and internal business areas by providing renewal-related analyses and responding to data requests.
• Maintains accurate documentation and supports the execution of renewal activities in accordance with established policies and procedures.
• Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices.
• May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.

MINIMUM QUALIFICATIONS:

Education and Experience: Bachelor's degree in Business Administration with a concentration in Statistics, Finance, Quantitative Methods, Mathematics, Economics, or a related field. Minimum of two (2) years of experience in data analysis, health insurance underwriting, pricing, financial analysis, or fully insured group account renewals. Experience working with databases, reporting tools, and quantitative analysis is preferred. Experience within the health insurance industry is highly desirable.

“Proven experience may be replaced by previously established requirements.”

Certifications / Licenses: N/A

Other: N/A

Languages:

Spanish – Intermediate (comprehensive, writing and verbal)

English – Intermediate (comprehensive, writing and verbal)

“We are an Equal Employment Opportunity Employer and take Aff…

MCS Healthcare Holdings, LLC. (MCS)is an Equal Employment Opportunity Employer and take