Lead Medical Risk Underwriter

2 weeks ago

Washington, United States Highmark Health Full time

Company :

Highmark Health

Job Overview :

POSITION SUMMARY

The role involves evaluating and pricing insurance proposals while analyzing the contractual framework for groups based on their claims history and demographic characteristics. The individual will exercise Underwriting discretion within the guidelines of Highmark Health, ensuring sustained profitability and growth. This position requires the ability to discern when to reject proposals that do not align with the overarching business strategy and risk profile. Responsibilities include assessing risk elements for new enrollments, annual renewals, and modifications of group insurance agreements or self-funded plans, adhering to established underwriting standards and practices. The incumbent will continuously review relevant policies, guidelines, and market intelligence to enhance risk management and optimize enrollment or manage existing memberships. The analysis will encompass financial health of organizations, participation rates, industry types, employee group characteristics, and historical claims data to determine available benefits and set appropriate rates. The role includes preparing comprehensive reports and providing justification and support to various stakeholders regarding underwriting outcomes, rate calculations, and financial performance. The incumbent will also offer expense projections and precise evaluations of financial documents, while providing mentorship and guidance to junior Underwriters.

KEY RESPONSIBILITIES

  • Manage a portfolio of renewing accounts and generate new business at profitable levels to assist Highmark Health in achieving its overall business objectives.
  • Utilize diverse systems and tools to gather necessary data and accurately execute and monitor assigned tasks.
  • Calculate rates, implement various financial arrangements, interpret pricing policies, and adapt to exceptional circumstances.
  • Identify suspicious claim trends among renewal clients and assess competitor claims experiences for prospective clients, developing strategies to address these issues.
  • Apply corporate risk management protocols and make adjustments for unique scenarios that may not be covered by standard pricing formulas.
  • Recognize instances of non-compliance with corporate risk management policies, disclosure requirements, or enrollment criteria.
  • Propose suitable modifications to pricing within the relevant policy/guideline to accommodate specific client situations.
  • Evaluate member risk and collaborate with internal departments to manage this risk effectively.
  • Support various internal initiatives, including but not limited to fraud detection, corporate compliance, wellness programs, and product development efforts.
  • Complete renewals, prospect quotes, and review the work of junior analysts in line with production and timeliness standards.
  • Adapt to shifting priorities as quotes are received from different markets and adjust to new demands and requirements.
  • Communicate policy adaptation recommendations to accommodate client-specific situations, supported by clear rationale or management principles.
  • Influence sales and external stakeholders towards appropriate risk solutions.
  • Guide and provide technical support to junior analysts.
  • Take primary responsibility for maintaining departmental tools and processes as assigned.
  • Represent departmental interests on system development and process improvement teams as required.
  • Perform other duties as assigned or requested.

EDUCATIONAL REQUIREMENTS

Essential

  • Bachelor's Degree in Mathematics, Actuarial Science, Finance, Business, Computer Science, or a related quantitative analysis field.

Substitutions

  • 6 years of relevant, progressive experience in the area of specialization.

EXPERIENCE REQUIREMENTS

Essential

  • 5 - 7 years of experience in underwriting self-funded plans and transitioning fully insured prospects to self-funding.

SKILLS AND COMPETENCIES

  • Proficient in collaborating with various internal departments and external stakeholders.
  • Ability to utilize relevant computer systems, electronic tools, and applications.
  • Capable of working independently and managing projects ranging from routine to highly complex.
  • Demonstrates understanding and support of corporate and departmental goals and initiatives.
  • Exhibits ethical business practices with adherence to all privacy and confidentiality regulations.
  • Strong problem-solving, organizational, and negotiation skills are essential.
  • Excellent mathematical aptitude required for analysis.

TRAVEL REQUIREMENT

0% - 25%

WORKING CONDITIONS

Office-based position with occasional travel to various work sites.

PHYSICAL DEMANDS

Ability to lift up to 10 pounds consistently; occasional lifting of 10 to 25 pounds.

DISCLAIMER: This job description is intended to provide a general overview of the position and does not encompass all duties, responsibilities, and qualifications required for the role.

COMPLIANCE REQUIREMENT: This position adheres to ethical and legal standards as outlined in the company's code of conduct and policies.

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