Group Renewal Senior Underwriter

4 days ago

Farmington, New Mexico, United States Medical Card System, Inc. Full time

Group Renewal Senior Underwriter
Regular

Exempt

GENERAL DESCRIPTION:


Responsible for analyzing, collecting, and interpreting utilization, product, and benefits information on the health coverage of the MCS Life Insurance In-House Account segment.

This aims to calculate group health and life renewal rates to establish adequate premium volumes, thus establishing the profitability levels expected by the corporation.

Responsible for maintaining and updating the tools available for group renewal. In charge of organizational technological development projects that may impact the unit.

ESSENTIAL FUNCTIONS:

  • Operates and uses MCS Life systems to extract and handle information on copayment structures, deductibles, coinsurance, coverage codes, rate structures, licenses, coverage claims paid, demographics of the assessed population, high-impact claims in both medical and pharmacy coverage, billed and paid claims, commission levels, among others, to establish during the renewal process appropriate rates levels and premium volumes for the currently insured groups under MCS Life for the fully insured segment.
  • Uses and modifies the statistical methodology and models designed to interpret and closely analyze the historical utilization patterns within the health coverage of the groups currently insured by MCS Life for the fully insured segment.
  • Calculates actuarial impacts for changes in copayments, deductibles, and coinsurance and applies them to the claim projection.
  • Interprets and analyzes the prognosis provided by the Medical Affairs unit related to high impact claims to adjust (increase or decrease) the claim projection during the renewal process of the "fully insured" accounts.
  • Analyzes information on medical conditions and medicines obtained through different sources to reach conclusions on cases affecting the utilization patterns of the renewals of the fully insured accounts.
  • Uses actuarial factors and variables that significantly impact the pricing of fully insured account renewals.
  • Analyzes the renewals from previous years, if necessary.
  • Prepares the claim projection considering all the analyses.
  • Determines, consults, and establishes with the immediate supervisor in extremely complex cases the risk levels, rate structure, and premium volume of the "fully insured" accounts to protect the Company from possible financial losses.
  • Maintains an effective communication channel with the Account Executives and supports them in the processes and negotiations of the renewals.
  • Retrospective Premium Agreements (one-two way), evaluate existing contracts' performance and give visibility of the financial impact to senior management.
  • Advises Account Executives with recommendations on copayment structures, deductibles, and coinsurance to improve the negotiation processes of "fully insured" account renewals.
  • Occasionally serves as a liaison between the agent/broker and the insurance company during the negotiation process.
  • Responsible for monthly updating of the data of the commercial portfolio of the evaluation models available in the fully insured renewals unit. Responsible for working on improvements, adjustments, and/or updates to existing work models, adjusting them according to business needs.
  • Unit subject matter expert on tool development projects.
  • Serve as support to other units within the underwriting team as needed.
  • Responsible for commercial portfolio reports to upper management.
  • Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices.
  • May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.

MINIMUM QUALIFICATIONS

Education and Experience:
Bachelor's degree in Business Administration with a specialization in Statistics, Finance, Quantitative Methods, or Economics, Natural Sciences with a focus on Mathematics. At least five (5) years of experience working on fully insured account renewals and database management, preferably within the Health Insurance Industry.

"Proven experience may be replaced by previously established requirements."

Certifications / Licenses: N/A

Other: N/A

Languages:

Spanish - Intermediate (comprehensive, writing and verbal)

English - Intermediate (comprehensive, writing and verbal)

"Somos un patrono con igualdad de oportunidad en el empleo y tomamos Acción Afirmativa para reclutar a Mujeres, Minorías, Veteranos Protegidos y Personas con Impedimento"

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