Pharmacy Underwriter / Actuarial Analyst

HMSA • Honolulu, HI

23d • Hybrid

About The Position

The Pharmacy Underwriter / Actuarial Analyst monitors emerging pharmacy expenses and rebate trends and supports trend forecasts for financial projections, rating, and performance monitoring. The role calculates and analyzes self-funded employer group pharmacy rates using historical account utilization, validates account data and risk composition, and produces and audits rate renewals, rate filing worksheets, and exhibits for moderately to highly complex accounts. It also provides consultation to Account Management and Sales on rating rationale and practices, collaborating with underwriting and account management to ensure rates and financial options are appropriate.

The position creates revenue and expense projections at the group and line-of-business levels, monitors emerging experience against projections, and prepares regular variance analyses. It partners with account management and underwriting staff on new and renewal rating discussions, interfaces with external brokers, consultants, and accounts, provides input on underwriting guidelines and procedures, and supports development and maintenance of HMSA's commercial pharmacy group rating engine. Other duties may be assigned.

Requirements

• Bachelor's degree and three years of related experience in pharmacy underwriting, or an equivalent combination of education and work experience.
• Ability to work quickly and accurately with basic math formulas and concepts, including fractions, percentages, ratios, and proportions, and apply mathematical logic in practical situations.
• Ability to read and interpret documents such as group agreements, financial reports, and procedure manuals.
• Knowledge or experience with medical insurance plans and rating methods.
• Proficiency with group underwriting concepts, practices, and procedures.
• Basic knowledge of Microsoft Office applications, including Word, Excel, and Outlook.

Responsibilities

• Monitor emerging pharmacy expenses and rebate trends and support development of trend forecasts for financial projections, rating, and performance monitoring.
• Calculate and analyze self-funded employer group pharmacy rates using historical account utilization; extract and analyze account history to ensure accuracy and sound logic.
• Analyze group composition and risk; produce and audit rate renewals, rate filing worksheets, and exhibits for moderately to highly complex accounts, researching issues outside established guidelines as needed.
• Consult with Account Management and Sales on rating rationale and best practices for highly complex accounts, and collaborate with underwriting and account management to ensure rates and financial options are appropriate.
• Create group- and line-of-business-level revenue and expense projections, monitor experience against projections, and prepare regular variance analyses.
• Partner with account management and underwriting staff on new and renewal rating discussions; interface with external brokers, consultants, and accounts.
• Provide input regarding underwriting guidelines and procedures.
• Support development, maintenance, and enhancements of HMSA's commercial pharmacy group rating engine.
• Perform other miscellaneous duties and responsibilities as directed or assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level