Senior Medical Stop Loss Underwriter

2 hours ago

Jefferson City, Missouri, United States Highmark Health Full time
Job Summary

We are seeking a highly skilled Senior Medical Stop Loss Underwriter to join our team at Highmark Health. As a key member of our underwriting team, you will be responsible for pricing quotes and analyzing the structure of contracts for groups based on claims experience, employee group characteristics, and other relevant factors.

You will use your discretion and underwriting authority to ensure that our policies align with the company's overall strategy and risk structure. Your expertise will be essential in identifying opportunities to decline quotes that do not fit our risk profile and in analyzing risk factors for new enrollments, annual renewals, and amendments to group insurance contracts or self-funded plans.

Key Responsibilities
  • Price quotes and analyze contract structures for groups based on claims experience, employee group characteristics, and other relevant factors.
  • Use discretion and underwriting authority to ensure that our policies align with the company's overall strategy and risk structure.
  • Analyze risk factors for new enrollments, annual renewals, and amendments to group insurance contracts or self-funded plans.
  • Identify opportunities to decline quotes that do not fit our risk profile.
  • Develop recommendations to account for questionable claim patterns and issues with competitor's claims experience.
  • Apply corporate risk management policies and adjust for unusual situations that may not have been considered in the standard pricing formula.
  • Recommend appropriate adaptations of pricing within policy guidelines to accommodate client-specific situations.
  • Analyze member risk and engage internal departments to manage this risk.
  • Support other internal initiatives, including fraud detection, corporate compliance, wellness/disease management, and product development efforts.
  • Complete renewals, prospect quotes, and 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.
  • 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.
Requirements
  • Bachelor's Degree in Mathematics, Actuarial Science, Finance, Business, Computer Science, or other quantitative analysis discipline.
  • 5-7 years' experience in underwriting of self-funded and converting fully insured prospects to self-funding.
  • 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.
Preferred Qualifications
  • 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).
Language and Travel Requirements

English is the primary language used in this role. Travel requirements are minimal, with occasional travel from the office to various work sites or from site-to-site.

Physical, Mental Demands, and Working Conditions

This is an office-based position that requires occasional travel. The incumbent will be required to lift up to 10 pounds and work in a fast-paced environment.

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