Senior Medical Stop Loss Underwriter

Highmark Health•Carolina, PA

9h•Onsite

About The Position

The Senior Medical Stop Loss Underwriter prices quotes and analyzes contract structures for groups based on claims experience, employee-group characteristics, and other risk factors. The role exercises underwriting discretion within HM Insurance Group policies to support appropriate profitability and growth, including identifying quotes that do not fit the company’s strategy or risk structure. The underwriter evaluates new enrollments, annual renewals, and contract amendments for group insurance and self-funded plans according to established underwriting policies, practices, and standards. The role also analyzes policies, guidelines, and market data to improve risk management and support appropriate enrollment or management of existing membership. The position manages a book of renewing accounts and new business, develops rates and financial arrangements, and prepares reports and rationale regarding underwriting results, rate computations, and financial activity. It provides expense estimates and analyzes financial exhibits. The senior underwriter also reviews and supports lower-level analysts and represents departmental needs in assigned system-development and process-improvement work. The role is office-based, requires a physical work site, and involves travel of 0%–25%.

Requirements

Bachelor’s degree in Mathematics, Actuarial Science, Finance, Business, Computer Science, or another quantitative-analysis discipline; alternatively, six years of relevant, progressive experience in the area of specialization.
5–7 years of experience underwriting self-funded business and converting fully insured prospects to self-funding.
Skilled and knowledgeable interaction with internal departments and external stakeholders.
Ability to use applicable computer systems, electronic tools, and applications.
Ability to work independently and take responsibility for projects ranging from routine to highly complex.
Understanding of and support for corporate and departmental goals and initiatives.
Ethical business practices and adherence to privacy and confidentiality policies and regulations.
Good problem-solving, organizational, and negotiation skills.
Excellent mathematical aptitude.

Nice To Haves

Actively pursuing a professional designation related to the healthcare industry and willing to complete one course within twelve months in LOMA, CEBS, or AHIP.

Responsibilities

Manage a book of renewing accounts and write new business at profitable levels to support HMIG business targets or assigned volumes of new applications or RFPs.
Use systems and tools to obtain data, complete assigned work accurately, and track work.
Calculate rates, apply different financial arrangements, interpret pricing policy, and adapt to unusual situations.
Identify questionable claims patterns among renewal clients and issues in prospect clients’ competitor claims experience, and develop recommendations to address them.
Apply corporate risk-management policies and adjust for unusual situations not addressed by standard pricing formulas.
Identify client noncompliance with risk-management policies, disclosure rules, or enrollment conditions and criteria.
Recommend appropriate pricing adaptations within policy and guidelines for client-specific or individual situations, with clear rationale.
Analyze member risk and engage internal departments to manage it.
Support initiatives such as fraud detection, corporate compliance, wellness and disease management, and product development.
Complete renewals and prospect quotes, and review lower-level analyst work in accordance with production and timeliness standards.
Adapt to changing priorities and requirements as quotes arrive from different markets.
Influence sales teams and external audiences, including brokers and TPAs when necessary, toward appropriate risk solutions, pricing, and quote structures.
Guide, assist, and provide technical support to lower-level analysts.
Assume primary responsibility for maintaining departmental tools and processes, as assigned.
Represent departmental perspectives and needs on system-development and process-improvement teams, as assigned.
Prepare reports and provide underwriting, rate-computation, and financial-activity rationale and support to internal teams, clients, and potentially producers.
Provide expense estimates and accurate analysis of financial exhibits.
Perform other duties as assigned or requested.