Senior Underwriter (Medical Insurance)

Highmark Health; Atlanta (GA); Presencial; USD 79.000 - 127.000; Jornada completa

Descripción de la vacante

HM Insurance Group in the United States is seeking an experienced underwriter to price quotes and analyze group contracts based on claims experience and employee group characteristics. The role ensures profitability and growth by applying underwriting policies and risk strategies.

The ideal candidate has 5–7 years of underwriting experience with self-funded plans, strong math aptitude, and the ability to coordinate with internal teams while maintaining privacy and compliance standards.

Formación

• Bachelor\'s degree in mathematics, actuarial science, finance, business, CS, or other quantitative field.
• 6 years of relevant, progressive underwriting experience.
• 5–7 years of underwriting experience with self-funded and converting prospects to self-funding.
• Understanding of LOma/CEBS/AHIP preferred licensure would be a plus.

Responsabilidades

• Renewals and new business pricing to meet profitability targets.
• Use systems and tools to obtain data and complete work accurately.
• Identify questionable claim patterns and adjust pricing recommendations.
• Apply risk management policies and adapt pricing to client needs.
• Support internal initiatives like compliance, fraud detection, and product development.

Conocimientos

Stakeholder collaboration

Data systems

Independent work

Corporate goals

Privacy compliance

Math aptitude

Negotiation skills

Educación

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

Descripción del empleo

Company

HM Insurance Group

Job Description

JOB SUMMARYThis 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’sGuide, 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 TypeOffice-basedTeaches / trains others regularlyOccasionallyTravel regularly from the office to various work sites or from site-to-siteRarelyWorks primarily out-of-the office selling products/services (sales employees)NeverPhysical work site requiredYesLifting: up to 10 poundsConstantlyLifting: 10 to 25 poundsOccasionallyLifting: 25 to 50 poundsRarely

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

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.

California Consumer Privacy Act Employees, Contractors, and Applicants Notice