Group New Business Underwriter

2 months ago

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

Group New Business Underwriter
Regular

Exempt

GENERAL DESCRIPTION:


Responsible for analyzing, collecting, and interpreting competitor utilization information, products, and benefits to calculate group health and life rates and establish adequate premium volumes.

This aims to demonstrate the profitability levels expected by the corporation for the commercial segment.

ESSENTIAL FUNCTIONS:

  • Analyze and interpret data on utilization, paid claims, paid and billed premiums, demographics, high-impact claims, experiences, and other related information in competitor reports to prepare proposals and RFPs for new groups (fully insured and Self-Insured).
  • Explore information related to the products and benefits of the competing companies' health coverage to compare with companies' products during the quotation analysis.
  • Operates and uses systems to extract, handle, and obtain information from co-payment 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, commission levels, among others, to establish, during the renewal process, appropriate levels of administrative expenses for the segment of the currently self-insured groups.
  • Quotes and gives rates for the financing methods of Experience Rating, Retrospective (one way, two way) Accounting Agreement, Reimbursement Agreement, Cost Plus, ASO, and Specific & Aggregate Stop Loss. Prepares the history of paid claims (both Cost-Plus groups renewals and prospects) to determine the annual fluctuations in administrative expenses and computes a proposal to calculate COBRA rates and equivalent premium rates per coverage.
  • Prepares the claim projection and appropriately uses the actuarial factors and variables that significantly impact it.
  • Uses and modifies the statistical methodology designed to interpret and closely analyze the historical utilization patterns within the health coverage of the renewals of the Cost-Plus groups and the fully insured and Cost-Plus prospects.
  • Calculates actuarial impacts for changes in copayments, deductibles, and coinsurance and applies them to the claim projection.
  • Interprets and analyzes the prognosis provided regarding high-impact claims to adjust (increase or decrease) the claim projection during the renewal process of the Cost-Plus accounts.
  • Analyzes information on medical conditions and medicines obtained through different sources to reach conclusions on cases affecting the utilization patterns of renewals and prospects.
  • Adequately uses actuarial factors and variables with a significant impact on the rates for the prospects of the fully insured accounts and on the claim projection of the ASO / Cost Plus accounts.
  • Determines, consults, and establishes with the immediate supervisor in extreme complexity cases the risk levels, the structure of the administrative expenses of the Cost-Plus accounts, the structure of the Stop Loss premiums, and the rate structure of the "fully insured" prospects to protect the Company from possible financial losses.
  • Provides information on high-impact claims, claims paid for coverages, group demographics, and any other information required by reinsurance to establish the renewal provision or for a quotation when the Stop Loss of the Cost-Plus groups is made through an external reinsurance company.
  • Maintains an effective communication channel with the other departments related to the processes and negotiations of renewals and quotations.
  • Gives recommendations on copayment structures, deductibles, and coinsurance to improve the negotiation processes of renewals and quotations.
  • As requested, serves as a liaison between the agent/broker and the insurance company during the negotiation process.
  • Confirm with the management any exceptions that deviate from the rules to establish the corresponding course of action.
  • Researches, collects, and analyzes information to create special reports.
  • 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: Master's degree in Business Administration, Biostatistics, or Mathematics. At least two (2) to (3) three years of experience working with quotations, proposal requisitions (RFPs), auctions, Cost Plus/ASO groups, and reinsurance contracts in an Underwriting department, preferably in the Health Insurance industry.

OR
Bachelor's degree in Natural Sciences with a specialization in Mathematics. Bachelor's degree in Business Administration specializing in Statistics, Finance, Quantitative Methods, Economics, or Accounting.

At least four (4) years of experience working with quotations/renewals, RFPs, auctions, Cost Plus/ASO groups, Fully Insured, and reinsurance contracts in an Underwriting Department in the Health Insurance Industry.


Certifications / Licenses: N/A Other: N/A

Languages:

Spanish - Advanced (comprehensive, writing and verbal)

English - Advanced (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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