Senior Medical Stop Loss Underwriter

HM Insurance Group; United States; On-site; USD 79,000 - 127,000; Full time

Job summary

HM Insurance Group prices quotes and analyzes the structure of group contracts based on claims experience and employee group characteristics. You will use underwriting authority within HMIG policies to ensure profitability and growth, declining quotes that do not fit the strategy.

You will assess risk factors for enrollment, renewals, and amendments, prepare reports, and provide rationale to clients and producers.

Qualifications

• 5-7 years underwriting experience in self-funded and converting fully insured prospects.
• Bachelor's Degree in a quantitative field is required.
• Ability to work independently and manage projects.
• Strong math aptitude and problem-solving skills.

Responsibilities

• Renew accounts and write new business at profitable levels.
• Calculate rates and interpret pricing policies.
• Identify questionable claim patterns in renewal clients.
• Apply corporate risk management policies and adjust pricing.
• Recommend pricing adaptations for client-specific situations.
• Guide and mentor lower level analysts.
• Support fraud detection and compliance initiatives.

Skills

Stakeholder management

Analytical thinking

Problem solving

Negotiation

Independent work

Ethical standards

Strong communication

Education

Bachelor's Degree in Mathematics, Actuarial Science, Finance, Business, Computer Science or other quantitative analysis discipline

5-7 years underwriting experience in self-funded and converting fully insured prospects

Job description

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.

• 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.

Company

HM Insurance Group

Job Description

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

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

Pay Range Minimum

$79,300.00

Pay Range 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.

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.

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