Senior Medical Stop Loss Underwriter

Highmark Health; Pennsylvania; Hybrid; USD 79,000 - 127,000; Full time

Job summary

HM Insurance Group is seeking an experienced underwriter to price quotes, analyze contract structures, and assess risk for group plans. You will work within the HMIG framework, ensuring profitability and growth in line with company strategy and policies.

Responsibilities include analyzing enrollment data, preparing financial exhibits, and providing guidance to junior underwriters. Strong collaboration with sales, brokers, and internal teams is essential to optimize pricing and risk solutions.

Qualifications

• Bachelor's degree required in a quantitative field; substitutions: 6 years relevant experience.

Responsibilities

• Manage a book of business for renewals and profitable new business.
• Calculate rates and apply pricing policies for quotes.
• Analyze risk factors and adherence to underwriting policies and guidelines.
• Prepare reports on underwriting results, rate computations and financial activity.

Skills

Stakeholder management

Tech proficiency

Independence

Goal alignment

Privacy compliance

Problem solving

Math aptitude

Education

Bachelor's degree in Mathematics, Actuarial Science, Finance, Business, Computer Science

Job description

Company : HM Insurance Group

Job Summary

This job prices quotes and analyzes the structure of a contract for a group based on claims experience, characteristics of the employee groups, etc. The incumbent uses discretion of Underwriting authority within the policies of HMIG and ensures appropriate levels of profitability and growth over time. Identifying when to decline quotes that do not fit into the overall HMIG strategy and risk structure. Analyzes risk factors for new enrollment, annual renewals, and amendments of group insurance contracts or of self‑funded plans in conformance with established underwriting policies, practices, and standards. Analyzes associated policies, guidelines, market data to continuously improve risk management and gain appropriate enrollment or manage existing membership. Analyzes data such as financial conditions of the organization, participation percentage, type of industry, characteristics of employee groups, or past claim experience to determine what benefits can be offered and to set the rates. Prepares a variety of reports and provides rationale and support to other areas within the organization, clients, and possibly producers regarding one or more of the following: underwriting results, rate computations and financial activity. Provides expense estimates and accurate analysis of financial exhibits. The incumbent provides oversight, guidance and/or assistance to lower level HMIG Underwriters.

Essential Responsibilities

Responsible for a book of business of renewing accounts and writing new business at profitable levels to help HMIG achieve overall business targets or assigned volume of new applications or RFP’s. Utilize various systems and tools to obtain necessary data and accurately complete and track assigned work. Calculate rates, employ different financial arrangements, interpret pricing policy and adapt to unusual situations. Identify questionable claim patterns of renewal clients and issues with competitor’s claims experience for prospect clients and develops recommendations to account for these situations. Apply corporate risk management policies and adjust for unusual situations that may not have been considered in the standard pricing formula. Identify when clients do not comply with corporate risk management policies, disclosure rules, or conditions/criteria for enrollment. Recommend appropriate adaptation of pricing within the appropriate policy/guideline to accommodate each client specific or individual situation. Analyze member risk and engage internal departments to manage this risk. Support other internal initiatives which may include but not limited to fraud detection, corporate compliance, wellness/disease management, and product development efforts. Complete renewals, prospect quotes, review of lower level analyst work in accordance with production and timeliness standards. Adapt to changing priorities as quotes come in from different markets and adapt to new priorities and requirements. Communicate recommendations of policy adaptation to accommodate client‑specific situations supported by a clear rationale or management principles. Influence sales and external audiences toward appropriate risk solutions. Influence sales team towards the appropriate pricing and structure of each quote. When necessary, influence other market partners, e.g. brokers and TPA’s Guide, assist and provide technical assistance to lower level analysts. Assume primary support for maintenance of departmental tools and processes, as assigned, Represent departmental perspectives and needs on system development and process improvement teams, as assigned, Other duties as assigned or requested.

Education

Required Bachelor's Degree in Mathematics, Actuarial Science, Finance, Business, Computer Science or other quantitative analysis discipline Substitutions 6 years relevant, progressive experience in the area of specialization Preferred None

Experience

Required 5 - 7 years' experience in underwriting of self‑funded and converting fully insured prospects to self‑funding Preferred None

Skills

• Skilled and knowledgeable interaction with various internal departments and external stakeholders
• Ability to use applicable computer systems, electronic tools and applications
• Ability to work independently and assume responsibility for projects across a continuum from routine to highly complex
• Demonstrate an understanding and support of corporate and departmental goals and initiatives
• Demonstrate ethical business practices with adherence to all privacy and confidentiality policies and regulations
• Good problem‑solving, organizational, and negotiation skills required
• Excellent math aptitude required to complete analysis

Required Licensure

None

Preferred Licensure

Actively pursuing a professional designation related to the healthcare industry and be willing to complete one course within twelve months in either Life Office Management Association (LOMA) Certified Employee Benefit Specialist (CEBS), or America's Health Insurance Plans (AHIP)

Language (Other than English)

None

Travel Requirement

0% - 25%

Physical, Mental Demands and Working Conditions

Position Type Office‑based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site‑to‑site Rarely Works primarily out‑of‑the office selling products/services (sales employees) Never Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Rarely

Disclaimer

The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement

This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range

• Minimum: $79,300.00
• Maximum: $127,100.00

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Equality and Diversity

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

Privacy Notice

California Consumer Privacy Act Employees, Contractors, and Applicants Notice Highmark Health is a national, blended health organization that includes one of America’s largest Blue Cross Blue Shield insurers and a growing regional hospital and physician network. Based in Pittsburgh, Pa., Highmark Health’s 35,000 employees serve millions of customers nationwide through the nonprofit organization’s affiliated businesses, which include Highmark Inc., Allegheny Health Network, HM Insurance Group, United Concordia Dental, HM Health Solutions and HM Home & Community Services. Highmark Health’s businesses proudly serve a broad spectrum of health‑related needs including health insurance, health care delivery, population health management, dental solutions, reinsurance solutions, and innovative, technology solutions.