Senior Medical Underwriter for Group & Self-Funded Plans

Highmark Health; Oklahoma; Sur place; USD 79 000 - 127 000; Plein temps

Résumé du poste

HM Insurance Group prices quotes and analyzes group contracts based on claims experience and employee group characteristics. The incumbent uses underwriting authority within HMIG policies to ensure profitability and growth, renewing accounts and evaluating new business for self-funded or converting plans.

The role requires analysis of risk factors, preparation of reports, and guidance to clients and producers.

Qualifications

• Bachelor's degree in Mathematics, Actuarial Science, Finance, Business, Computer Science or other quantitative analysis discipline.
• 6 years relevant, progressive experience in the area of specialization.

Responsabilités

• 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 RFPs.
• 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.

Connaissances

Stakeholder management

Tech proficiency

Independent work

Business alignment

Privacy compliance

Problem solving

Math aptitude

Formation

Bachelor's degree in quantitative field

6 years relevant progressive experience

Description du poste

HM Insurance Group prices quotes and analyzes group contracts based on claims experience and employee group characteristics. The incumbent uses underwriting authority within HMIG policies to ensure profitability and growth, renewing accounts and evaluating new business for self-funded or converting plans.

The role requires analysis of risk factors, preparation of reports, and guidance to clients and producers.