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About the Role

This job prices quotes and analyzes the structure of a contract for a group based on claims experience and employee group characteristics. The incumbent uses discretion of Underwriting authority within HMIG policies to ensure profitability and growth, identifying quotes that do not align with HMIG strategy. Analyzes risk factors for new enrollments, renewals, and amendments of group insurance contracts or self-funded plans, adhering to underwriting policies. Analyzes associated policies, guidelines, and market data to improve risk management and manage membership. Analyzes data such as financial conditions, participation percentage, industry type, employee group characteristics, or past claim experience to determine benefits and set rates. Prepares reports and provides rationale to internal departments, clients, and producers regarding underwriting results, rate computations, and financial activity. Provides expense estimates and accurate analysis of financial exhibits. The incumbent provides oversight, guidance, and assistance to lower-level HMIG Underwriters.

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 RFPs.
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 TPAs.
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.

Requirements

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 (as substitution for degree)
5 - 7 years' experience in underwriting of self-funded and converting fully insured prospects to self-funding
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)
Compliance with ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
Compliance with HIPAA and data security guidelines.
Compliance with the company’s Code of Business Conduct, including adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

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
Excellent math aptitude

Location

Office-based

Work Type

Office-based
Teaches / trains others regularly
Travel regularly from the office to various work sites or from site-to-site (Rarely)

Experience Level

5 - 7 years' experience in underwriting of self-funded and converting fully insured prospects to self-funding
6 years relevant, progressive experience in the area of specialization

Education Level

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

Salary/Compensations

$79,300.00 - $127,100.00

About the Company

HM Insurance Group

Equal Opportunity

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.
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