Medical Stop Loss Underwriter (Remote)

Company :HM Insurance GroupJob 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 ensure 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. This is a mid-level position, with little oversight by Management when performing the essential functions of the position. The job has knowledge and experience with Company procedures, policies and protocols.ESSENTIAL RESPONSIBILITIESResponsible 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. Utilizes various systems and tools to obtain necessary data and accurately complete and track assigned work.Calculaterates, employs different financial arrangements, interpretpricing policy, and adaptto unusual situations.Identifyquestionable claim patterns of renewal clients and issuewith competitor's claims experience for prospect clients and developrecommendations to account for these situations.Applycorporate risk management policies and adjust for unusual situations that may not have been considered in the standard pricing formula.Identifywhen clients do not comply with corporate risk management policies, disclosure rules, or conditions/criteria for enrollment. Recommendappropriate adaptation of pricing within the appropriate policy orguideline to accommodate each client-specific or individual situation.Analyzemember risk and engageinternal departments to manage this risk.Supportother internal initiatives which may include but is not limited to fraud detection, corporate compliance, wellness/disease management, and product development pleterenewals, prospect quotes, review of lower level analyst work in accordance with production and timeliness standards.Adaptto changing priorities as quotes come in from different markets and adapt to new priorities and requirements. Communicaterecommendations of policy adaptation to accommodate client-specific situations supported by a clear rationale or management fluenceSales team and external audiences toward appropriate risk fluenceSales team towards the appropriate pricing and structure of each quote. When necessary, influenceother market partners, e.g. brokers and TPAs.Guide, assist,and providetechnical assistance to lower level analysts.As assigned, assumeprimary support for maintenance of departmental tools and processes.As assigned, representdepartmental perspectives and needs on system development and process improvement teams.Other duties as assigned or requested.EDUCATIONRequiredBachelor's Degree in Mathematics, Actuarial Science, Finance, Business, Computer Science, or other quantitative analysis disciplineSubstitutions6 years relevant progressive experience in the area of specializationPreferredNoneEXPERIENCERequired3 - 5 years in Underwriting of self-funded and converting fully insured prospects into self-fundedPreferredNoneLICENSES or CERTIFICATIONSRequiredNonePreferredActively pursuing a professional designation related to the healthcare industry and be willing to complete one course within twelve (12) months in either Life Office Management Association (LOMA) Certified Benefit Specialist (CEBS) or America's Health Insurance Plans (AHIP)SKILLSSkilled and knowledgeable interaction with various internal departments and external stakeholdersAbility to use applicable computer systems, electronic tools and applicationsAbility to work independently and assume responsibility for projects across a continuum from routine to highly complexDemonstrate an understanding and support of corporate and departmental goals and initiativesDemonstrate ethical business practices with adherence to all privacy and confidentiality policies and regulationsGood problem-solving, organizational, and negotiation skills requiredExcellent math aptitude required to complete analysisTRAVEL REQUIRED0% - 25%LANGUAGE REQUIREMENT (other than English)NonePHYSICAL, MENTAL DEMANDS and WORKING CONDITIONSPosition TypeOffice-BasedTeaches / trains others regularlyRarelyTravel 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 poundsOccasionallyLifting: 10 to 25 poundsRarelyLifting: 25 to 50 poundsNeverDisclaimer: 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 pliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policiesAs 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.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.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, age, 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, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.EEO is The LawEqual Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity (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 contact HR Services Online at Consumer Privacy Act Employees, Contractors, and Applicants Notice

Created: 2024-10-19