Senior Underwriter - Medical Stop Loss

Job ID: J124043
Company: HM Life Insurance Company
Location: Pittsburgh, PA, United States
Full/Part Time: Full time
Job Type: Regular
Posted at: May 24, 2018

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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 - 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 Required (other than English):

None

Travel Required

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type:

Office-Based

Teaches / trains others regularly

Rarely

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

Occasionally

Lifting: 10 to 25 pounds

Rarely

Lifting: 25 to 50 pounds

Never

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 position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

Employee Referral Level 4

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 their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity (http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf)
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 number below.
For accommodation requests, please call HR Services at 844-242-HR4U or visit HR Services Online at HRServices@highmarkhealth.org

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