Director Underwriting & Pricing- Managed Care

Job ID: J124028
Company: HM Life Insurance Company
Location: Home, PA, United States
Full/Part Time: Full time
Job Type: Regular
Posted at: Jun 18, 2018

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Description

I.    GENERAL OVERVIEW:  
This management role will provide leadership and strategic direction in underwriting, pricing, and product development activities for the managed care reinsurance line of business.  As a key strategic position, the director will also serve as a subject matter expert in managed care data analytics, claims, policy language and filings for the line of business. Accountability for loss ratio management and ongoing profitability will be managed by this role in conjunction with the SVP, Managed Care Reinsurance.


II.    ESSENTIAL RESPONSIBILITIES:
1.    Leadership and Management: Provide leadership, supervision and direction to Managed Care Underwriting Director and team
•    Lead by example by developing clear and concise expectations
•    Support  company goals and strategy at the highest level instilling confidence in staff through communication and mentoring
•    Actively participate in strategic planning for line of business including presentations, research and other functions as needed
2.    Pricing: Lead managed care pricing and actuarial product development including final pricing decisions
•    Lead pricing model development; manage on an ongoing basis to ensure viability and profitability in the market
•    Provides ongoing evaluation of tools available in the market and works to achieve a best in class profitable pricing model
•    Assumes final underwriting authority on managed care pricing through management of underwriting guidelines and overall results
3.    Product Development: Key role in actuarial and pricing with significant input in product offering and design to the market.
•    Assess competitors positions and work with product team to develop HMIG positioning
•    Evaluate new opportunities from an actuarial and pricing perspective
•    Support underwriting, sales and operations in the implementation of new products and services
•    Participate regularly in industry conferences and additional Highmark networking as appropriate to enhance line of business
4.    Cross Functional Support: Collaborate with medical stop loss and other cross-functional teams
•    Provides subject matter expert support to other HMIG excess of loss products as needed
•    Collaborates and seeks  best practices across other product lines to benefit the line of business
•    Works across departments to ensure best in class product design including policy wording, filing, claims adjudication where direction is needed
5.    Profit/Loss: Measure and manage the profitability of the line of business
•    Develop and manage data warehouse needs for product line
•    Collaborate on reporting methodology tools to manage the business
•    Collaborate with other departments (sales, claims, medical management) to achieve desired results
6.    Other duties as assigned or requested.


III. QUALIFICATIONS:
Minimum

•    10 years’ experience in Managed Care pricing, underwriting and/or actuarial
•    Bachelor’s Degree in actuarial sciences, mathematics, business or related field
•    8 years’ experience managing profitable book of managed care business
•    5 or more years’ experience managing, coaching and mentoring a team
•    Ability to travel 20% of time  

  Preferred

 •    Stop loss analytics and detailed network evaluation experience
•    Co-op, start up government risk and or Exchange product underwriting and development experience at an excess, reinsurance level
•    FSA


Knowledge, Skills and Abilities  
•    Strong written and oral communication skills.
•    Strong relationship building skills.
•    Client focused with strong business acumen. 
•    Self-starter with the ability to work under pressure independently and as part of a team.
•    Ability to think strategically and act proactively to create strong trust and confidence with business units. 
•    Strong innovative problem-solving capabilities.
•    Ability to communicate ideas and concepts effectively with brokers, consultants, sales/field, and Senior Management•    


IV. SCOPE OF RESPONSIBILITY  
Does this role supervise/manage other employees- Yes 


V. WORK ENVIRONMENT
Is Travel Required- Yes

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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