Pharmacy Underwriter / Actuarial Analyst

HMSA; Honolulu (HI); Hybrid; USD 90,000 - 120,000; Full time

Benefits offered by this job

Hybrid work model

Job summary

HMSA in Honolulu, HI seeks a financial analytics professional to monitor pharmacy expenses, analyze self-funded employer group rates, and develop trend forecasts for financial projections. You will produce rate renewals, filing exhibits, and variance analyses while collaborating with underwriting and account teams to ensure competitive, accurate pricing.

Responsibilities include supporting the rating engine, interfacing with brokers and consultants, and performing additional duties as needed.

Qualifications

• Experience with rate renewals and rate filing worksheets is preferred.
• Strong analytical skills with attention to detail.
• Ability to explain underwriting rationale to internal teams.

Responsibilities

• Monitor emerging pharmacy expenses and rebate trends to support trend forecasts and financial projections.
• Calculate and analyze self-funded employer group pharmacy rates using historical utilization; prepare rate renewals and filing exhibits.
• Create revenue and expense projections at group and line-of-business levels; monitor experience vs projections and perform variance analyses.
• Collaborate with account management and underwriting; interface with brokers, consultants, and accounts; contribute to rating engine enhancements.
• Perform other duties as assigned.

Job description

1. Monitor emerging pharmacy expenses and rebate trends. Based on these and known/projected contract and other key drivers, support the development of trend forecasts to be used for financial projections, rating, and performance monitoring purposes.
2. Accurately calculate and analyze a variety of self-funded employer group pharmacy rates using the historical utilization of the account. Extract and analyze historical data of the account to ensure accuracy and good logic. Analyze the overall composition of the group to ensure that the total risk is not excessive. Produce and audit rate renewals, rate filing worksheets, and exhibits for moderately complex to highly complex accounts using pre-established guidelines and templates as a basis for analysis, performing necessary additional research on issues that fall outside these guidelines. Provide consultation to Account Management and Sales and explain rationale and best rating practices for highly complex accounts to assist in rate renewal process. Collaborating with the Underwriting team and account management team to ensure rates and financial options are appropriate.
3. Create revenue and expense projections at the group and line of business level. Monitor emerging experience against these projections and produce variance analyses on a regular basis.
4. Partner with account management and underwriting staff on new and renewal rating discussions. Interface with external brokers, consultants, and accounts. Provide input regarding underwriting guidelines and procedures. Support the development, maintenance and enhancements of HMSA's commercial pharmacy group rating engine.
5. Perform all other miscellaneous duties and responsibilities as directed or assigned.

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