Senior Health Plan Pricing Analyst

TriNet; Irvine (CA); On-site; USD 85,000 - 159,000; Full time

Benefits offered by this job

Medical, dental & vision plans

401(k) savings plan

Employee stock purchase plan

11 Company observed holidays, PTO and+

Comprehensive leave program

Job summary

TriNet is seeking a Senior Health Plan Pricing Analyst in Irvine to determine medical pricing based on risk and carrier requirements. You will review plans, analyze data, train peers, and collaborate with sales to ensure pricing accuracy.

Ideal candidates have 5+ years in insurance pricing, strong Excel skills, and comfort with complex self-funded cases. This role supports the Health Plan Pricing department and Insurance Services team.

Qualifications

• Bachelor’s degree or equivalent experience preferred.
• Typically 5+ years in insurance pricing or underwriting.
• Experience with trend analysis, risk forecasting and claims evaluation.
• Ability to interact with Sales to explain medical pricing guidelines, requirements, etc.
• Proficient in Microsoft Office; especially Excel.
• Salesforce.com knowledge is preferred.

Responsibilities

• Determine an appropriate medical price based on risk using multiple tools.
• Review prospect's current medical offerings.
• Ensure compliance with carrier requirements.
• Review complex cases such as self-funded groups.
• Collaborate with Sales colleagues.
• Assist in training of new colleagues and ongoing training.
• Other duties as assigned.
• Complies with all policies and standards.

Skills

Health plan pricing

Risk forecasting

Claims evaluation

Medical plan analysis

Independent thinking

Multi-tasking

Sales collaboration

Education

Bachelor's Degree or equivalent experience

Tools

Excel

Salesforce.com

Job description

TriNet is a leading provider of comprehensive human resources solutions for small to midsize businesses (SMBs). We enhance business productivity by enabling our clients to outsource their HR function to one strategic partner and allowing them to focus on operating and growing their core businesses. Our full-service HR solutions include features such as payroll processing, human capital consulting, employment law compliance and employee benefits, including health insurance, retirement plans and workers’ compensation insurance.

Don't meet every single requirement? Studies have shown that many potential applicants discourage themselves from applying to jobs unless they meet every single requirement. TriNet always strives to hire the most qualified candidate for a particular role, ensuring we deliver outstanding results for our small and medium-size customers. So, if you're excited about this role but your past experience doesn't align perfectly with every single qualification in the job description, nobody’s perfect – and we encourage you to apply. You may just be the right candidate for this or other roles.

A Brief Overview

The Senior Health Plan Pricing Analyst is responsible for multiple tasks within the department including ensuring the appropriate medical rate is assigned for a prospect. This role uses specialized tools developed by third party industry experts and TriNet's carrier partners to evaluate submitted documents and census information to determine the correct medical pricing for prospects based on the actual risk they present. In addition, their role is to assist the manager with the training of new colleagues as well as a primary liaison with carriers and the carrier pricing teams. This role will be an expert in the field of PEO health plan pricing having mastered the nuances of pricing and is a key contributor to the team. This position is part of the development process for grooming colleagues into the next level of leadership within the Insurance Services team and the Health Plan Pricing department.

What You Will Do

• Work independently to determine an appropriate medical price based on the risk of the group using multiple tools such as the parity testing tool and medical pricing tool
• Conduct review of a prospect’s current medical offerings
• Ensure compliance with all carrier partner requirements
• Review complex cases such as self-funded groups and those over 100 employees
• Actively collaborate with Sales colleagues
• Assist is with reviewing and evaluating the output of the tools and resources TriNet uses
• Assist in training of new colleagues and ongoing training of new colleagues
• Other project and responsibilities may be added at the manager's discretion
• Performs other duties as assigned
• Complies with all policies and standards

Education Qualifications

• Bachelor's Degree or equivalent experience preferred

Experience Qualifications

• Typically 5+ years in insurance pricing or underwriting required

Skills And Abilities

• Exceptional knowledge of health plan pricing
• Ability to interpret and analyze detailed medical plans and related documents
• Experience with trend analysis, risk forecasting and claims evaluation
• Ability to interact with Sales to explain medical pricing guidelines, requirements, etc.
• Proficient in Microsoft Office Suite; specifically with Excel
• Salesforce.com knowledge is preferred
• Ability to use mathematical skills to solve problems
• Demonstrates ability to exercise independent thinking and complete projects with little guidance
• Ability to handle multiple tasks and prioritize projects

Travel Requirements

Minimal

Work Environment

• Work in clean, pleasant, and comfortable office or home setting. The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable persons with disabilities to perform the essential functions.

The preferred location for this role is Irvine, CA, and the salary range for this location is $85,000.00 to $159,250.00. All qualified external applicants will be considered for an in-office role, based in Irvine. All qualified internal candidates are encouraged to apply and consider relocation to Irvine and may be considered for remote hire at the company’s discretion. The candidate’s final salary offer will be based on the candidate’s skills, education, work location and experience.

A candidate’s compensation may also include bonuses consistent with TriNet’s corporate bonus plan.

Additionally, subject to applicable eligibility requirements, TriNet offers permanent full-time employees a variety of benefits including medical, dental, and vision plans, life and disability insurance, a 401(K) savings plan, an employee stock purchase plan, eleven (11) Company observed holidays, PTO and a comprehensive leave program. Please click the following link for detailed information about our benefits offerings: https://www.trinet.com/documents/blt5b61a1040aae1904

Please Note: TriNet reserves the right to change or modify job duties and assignments at any time. The above job description is not all encompassing. Position functions and qualifications may vary depending on business necessity.

TriNet is an Equal Opportunity Employer and does not discriminate against applicants based on race, religion, color, disability, medical condition, legally protected genetic information, national origin, gender, sexual orientation, marital status, gender identity or expression, sex (including pregnancy, childbirth or related medical conditions), age, veteran status or other legally protected characteristics. Any applicant with a mental or physical disability who requires an accommodation during the application process should contact [e-mail] to request such an accommodation.