Hm Life Insurance Company
Job Description :
This job prices quotes and analyzes the structure of a contract based on claims experience and other characteristics of HMO managed care and provider excess reinsurance programs. The incumbent uses discretion of underwriting authority within the policies of HMIG and ensures appropriate levels of profitability and growth over time. Identifies 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 reinsurance programs in conformance with established underwriting policies, practices, and standards. Analyzes associated policies, guidelines, and 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 reinsurance programs, 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 Job Functions:
- 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.
- Bachelor’s degree in Mathematics, Actuarial Science, Finance, Business, Computer Science or other qualitative analysis discipline. 6 years relevant, progressive experience in the area of specialization can be substituted in lieu of Bachelor’s degree.
- 5 – 7 years Underwriting of Managed Care Reinsurance, Provider Excess or Healthcare reinsurance programs
- 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)
- Strong Microsoft Excel and/or Access ability
Knowledge, Skills, and Abilities:
- 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
Referral Bonus: Level 2
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