Excellus Health Plan Inc.
Large Group Underwriting I/II/III/IV - 021046 (Finance)
The Large Group Underwriter is responsible for determining acceptability of insurance risks and appropriate premium rates for large and complex group cases as well as managing the experience rated block of business to produce desired MLR and profit targets. Incumbent develops both new business rate proposals and renewal rates utilizing claim, premium and enrollment information available and interacts with company sales representatives and consultants regarding rate and trend explanations and rate negotiations. Additionally, incumbents propose and assist in the development of process improvements such as: assisting in the design, monitoring, and updating of the quoting process in conjunction with actuarial and sales; utilizing system and software applications to full potential.
Essential Responsibilities/Accountabilities:
All Levels:
· Calculates renewal rates using appropriate rating formulas and procedures and analyze projected financial impacts. Validates the final renewal rates and associated packaging is correct and ensures quality in rate releases.
· Creates quotes for prospective & existing customers using demographic characteristics and/or claims experience. Analyzes participation levels, contribution methodology, industry classification and other carrier information available. Performs applicable review of any necessary regulatory documentation. Applies knowledge of national and local competitive information to underwriting decisions. Facilitates the negotiation of final rates and or applicable administrative costs with enrolled and prospective customers.
· Evaluates benefit plan variations and partners with Sales in working directly with customer accounts, their brokers and consultants, in support of rate negotiations on new or renewal business.
· Partners with Sales in meeting persistency goals related to existing employer group business.
· Prepares documents for and facilitate discussions on executive rate reviews involving multiple levels of internal leadership and impacted business segments.
· Consults and coordinates with the Sales and Marketing Departments in support of specific group requirements through preparation of complex group reports and enforcement of product policies.
· Executes financial management on an assigned book of business.
· Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct and leading to the Lifetime Way values and beliefs.
· Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
· Regular and reliable attendance is expected and required.
· Performs other functions as assigned by management.
Level II (In addition to Level I responsibilities):
· Completes new business and renewal quotes for mid-segment and large accounts for dental and medical lines of business in all insured and/or claims based billed financial arrangements.
· Prepares settlements for alternatively funded groups (e.g., retrospectively rated, contingent premium, or Minimum Premium).
· Creates and maintain Experience Rated Monitoring and Book-of-Business tracking reports.
· Provides consultative analysis related to how Excellus products and discounts add value. Attends and contributes to meetings with internal and external stakeholders.
· Develops ad hoc reports as a supplement to the group underwriting process through query building and data extraction.
· May develop required premium/fees and analyze results for accuracy; makes appropriate decisions on how to proceed; analyzes inputs/outputs for reasonability.
· Proposes and/or assists in the development of process improvements utilizing system and software applications, such as Power BI, to full potential.
· Participates in cross training of Underwriting and Sales staff.
· Coordinates with other departments to ensure accuracy and consistency of overall account reporting.
· Understands, protects and educates on the financial health of the company by making sound business recommendations and making policy exceptions when appropriate.
Level III (In addition to Level II responsibilities):
· Interacts with internal and external sales representatives, accounts and consultants regarding rate and trend explanations and rate negotiations.
· Proposes and assists in development of process improvements and automation of processes within the Underwriting Team.
· Assists in ad hoc projects in support of the Sales, Marketing, and Actuarial Department initiatives.
· Interacts with internal sales representatives and consultants regarding rate and trend explanations and rate negotiations. Explains the components of rate changes to internal and external stakeholders.
· Represents department and/or division as a Subject Matter Expert for various technical/system/ training issues on cross functional workgroups. Communicates updates to leadership and recommends approaches for implementing change.
· Provides training and mentoring to other members of the Underwriting department including review and approval of case work, systems, department processes, implementation of new policies and procedures and assisting with departmental planning activities.
· Performs post-sale review.
· Assists in establishing Underwriting and Administrative procedures.
Level IV (In addition to Level III responsibilities):
· Responds to complex Requests for Proposal (RFP) questions and actively participates as part of the RFP response team.
· Evaluates and analyzes competitor rates/benefit plans for the development of trends and other renewal factors to be used in experience rating.
· Represents the Large Group Underwriting team in place of Underwriting management on high level, cross-functional work teams, such as Core End to End.
· Interacts with external customers regarding all Large Group Underwriting functions.
· Proposes and/or assists in the development of process improvements utilizing system and software applications.
· Updates and monitors departmental processes and procedures in compliance with system, regulatory and business requirements. Updates and maintains departmental reporting suites.
· Coordinates daily workflow activities of Underwriting staff.
· Reviews rate proposals from Underwriting staff.
· Assists in the technical development of Large Group Underwriters, which may include monitoring reports and workflow to provide recommendations on productivity and efficiency improvements.
Minimum Qualifications
NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities.
All Levels:
· BS in Math, Economics, Accounting, Finance, or Actuarial Science. In lieu of degree, 6 years of Underwriting or related experience may be considered.
· Knowledge of State and Federal Laws and Regulations relating to health insurance.
· Operational background with a strong ability to prioritize, plan and problem solve in a team environment.
· Good analytical skills with a focus on meeting expectations and requirements of both internal partners and external customers.
· Ability to extract and analyze data and implement process changes.
· Excellent verbal and written communication skills.
· Ability to perform under pressure and adapt to rapidly changing priorities.
Level II (in addition to Level I qualifications):
· Degree plus three or more years of experience in underwriting and/or relevant field.
· Knowledge of financial and risk health arrangements.
· Intermediate level in Microsoft Excel, Word, Access.
· Intermediate level in data extraction tools such as Cognos, Power BI, or SQL.
Level III (in addition to Level II qualifications):
· Degree plus five or more years of experience in underwriting and/or relevant field.
· Expert level in Microsoft Excel, Word, Access.
· Expert level in data extraction tools such as Cognos, Power BI, or SQL.
· Experience using software to benchmark actuarial guidelines for health rate setting.
Level IV (in addition to Level III qualifications):
· Degree plus seven or more years of experience in underwriting and/or relevant field.
· Experience must include all lines of business, funding arrangements, and related tasks.
· Ability to manage process requirements and suggest improvements for Rating tasks such as Rx Rebate Reconciliation and settlement processes.
· Ability to interact and defend rate assignment process at the group and/or broker level.
· Ability to assist in the workflow coordination of the team.
Physical Requirements
Ability to travel across regions.
The Lifetime Healthcare Companies aims to attract the best talent from diverse socioeconomic, cultural and experiential backgrounds, to diversify our workforce and best reflect the communities we serve.
Our mission is to foster an environment where diversity and inclusion are explicitly recognized as fundamental parts of our organizational culture. We believe that diversity of thought and background drives innovation which enables us to provide leading-edge healthcare insurance and services. With that mission in mind, we recruit the best candidates from all communities, to diversify and strengthen our workforce.
OUR COMPANY CULTURE:
Employees are united by our Lifetime Way Values & Behaviors that include compassion, pride, excellence, innovation and having fun! We aim to be an employer of choice by valuing workforce diversity, innovative thinking, employee development, and by offering competitive compensation and benefits.
In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.
Equal Opportunity Employer
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)
Non Manager