Company :Highmark Health
Job Description :
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 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.
- 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. Utilizes various systems and tools to obtain necessary data and accurately complete and track assigned work.
- Calculate rates, employs different financial arrangements, interpret pricing policy, and adapt to unusual situations.
- Identify questionable claim patterns of renewal clients and issue with competitor’s claims experience for prospect clients and develop 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 or 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 is 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 team 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.
- As assigned, assume primary support for maintenance of departmental tools and processes.
- As assigned, represent departmental perspectives and needs on system development and process improvement teams.
- Other duties as assigned or requested.
- 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
- 3 - 5 years in Underwriting of self-funded and converting fully insured prospects into self-funded
LICENSES or CERTIFICATIONS
- Actively 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)
- 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
0% - 25%
LANGUAGE REQUIREMENT (other than English)
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Teaches / trains others regularly
Travel regularly from the office to various work sites or from site-to-site
Works primarily out-of-the office selling products/services (sales employees)
Physical work site required
Lifting: up to 10 pounds
Lifting: 10 to 25 pounds
Lifting: 25 to 50 pounds
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
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 Minimum:$57,700.00
Pay Range Maximum:$106,700.00
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 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 Law
Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.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 contact HR Services Online at HRServices@highmarkhealth.org
California Consumer Privacy Act Employees, Contractors, and Applicants Notice