Senior Medical Stop Loss Underwriter

Highmark Health; Washington (District of Columbia); Remote; USD 67,000 - 126,000; Full time

Job summary

Highmark Health seeks a Senior Medical Stop Loss Underwriter to analyze contracts, manage risks, and ensure profitability. This dynamic role requires strong mathematical aptitude, negotiation skills, and the ability to influence internal teams. Qualified candidates will have 5-7 years of experience in underwriting and a bachelor's degree in a quantitative discipline.

Qualifications

• 5 - 7 years' experience in underwriting of self-funded insurance.
• Ability to interact with internal departments and external stakeholders.
• Understanding of risk management policies.

Responsibilities

• Analyze contracts for group based on claims experience.
• Calculate rates and employ financial arrangements.
• Prepare reports regarding underwriting results and financial activity.

Skills

Problem-solving

Organizational skills

Negotiation

Mathematical aptitude

Education

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

Job description

Thank you for your interest in employment at a Highmark Health company. Highmark Health uses an online application process. If you participate in the online application process through this Workday site, your personal information will be collected, including but not limited to data such as your resume and resume content, education, contact information, address, city, postal code, country, phone number, email address, IP address, as well as any other personal information you choose to provide. As part of the online application process, we will provide details such as how we will use the data that we collect and where such information is processed. We will also ask for your consent to use the data for purposes contained in the Highmark Health Data Protection Statement and the GDPR Data Protection Consent for Job Applicants, and for all other permissible purposes.

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Senior Medical Stop Loss Underwriter

Apply remote type Remote locations PA, Working at Home - Pennsylvania MD, Working at Home - Maryland WA, Working at Home - Washington NC, Working at Home - N Carolina LA, Working at Home - Louisiana time type Full time posted on Posted 7 Days Ago job requisition id J262391

Company :

HM Insurance Group

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.

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 InsurancePlans (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:

$67,500.00

Pay Range Maximum:

$126,000.00

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.

We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.

For accommodation requests, please contact HR Services Online at [e-mail]

California Consumer Privacy Act Employees, Contractors, and Applicants Notice

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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.