Senior Underwriter, Pharmacy

HCSC•Richardson, TX

About The Position

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development. BASIC FUNCTION Understand components of pharmacy pricing being able to articulate competitive differences of HCSC and competitor proposals to internal and external audiences. Confidently model and forecast Pharmacy analyses in a clear and concise manner and present to Management on a frequent basis. Act as Underwriting Pharmacy Subject Matter Expert supporting department in leading completion of RX quotes and RFPs. Ensure the retention and profitability of existing business through the calculation of appropriate renewal pricing. Utilize all currently available information, models, and knowledge to accurately predict future claims and non-claims expenses for Renewals and RFPs. Works closely with Management to provide alternate benefit plans, risk and/or funding arrangements. Be responsible for contracting on case work and update internal databases, etc. Coordinate with Proposal Unit to ensure accurate and timely RFP completion. Enforce adherence to Underwriting Guidelines and be responsible for approval of exceptions. Identify areas for potential process improvements and work with management to help in their development and implementation. Participate in project work with other departments. Maintain consistent high level of service to our sales representatives and clients with respect to renewal and proposal timeliness and accuracy. Monitor PBM and pharmacy market trends, competitor pricing, and regulatory changes to inform underwriting strategy. NOTE: relocation is NOT offered; sponsorship is NOT available either now or in the future.

Requirements

Bachelor's degree OR three (3) years of experience in a group health insurance function.
Three (3) years of experience underwriting cases of lesser complexity OR Demonstrated capability to meet required job responsibility.
Successfully demonstrated skills and experience in underwriting and pricing of various funding options and products and making sound decisions.
Math skills including the four basic math calculations (addition, subtraction, division & multiplication) and ability to estimate for mathematical reasonableness.
Successfully demonstrated interpersonal skills establishing and maintaining business relationships.
Independent judgment and problem resolution skills.
Work management skills including the ability to multi-task, prioritize, and manage time and workload to meet deadlines.
Verbal and written communication skills to include correct grammar, word choice, precision, conciseness, structure, audience appropriate tone and language.
PC proficiency to include Word and Excel.
Successfully Demonstrated skills and experience in presenting to external clients.
Extensive knowledge and skill applying state and federal legislation governing underwriting practices.
Effective Negotiation skills.
Successfully demonstrated skills for performing risk qualification.
Financial analysis and underwriting skills.
Successful experience achieving positive results dealing with customers, consultants and brokers.
Skills to deliver on the job training.

Nice To Haves

Extensive experience-based knowledge of group medical products, discount practices, stop loss and performance guarantees.
For Large Group: Demonstrated experience to underwrite experience rated and manually rated health insurance products with sound underwriting judgment.
Knowledge of the Blue System and ability to price National business.
Rotation through multiple UW market segments.

Responsibilities

Understand components of pharmacy pricing and articulate competitive differences.
Model and forecast Pharmacy analyses and present to Management.
Act as Underwriting Pharmacy Subject Matter Expert for RX quotes and RFPs.
Calculate appropriate renewal pricing to ensure retention and profitability.
Predict future claims and non-claims expenses for Renewals and RFPs.
Provide alternate benefit plans, risk and/or funding arrangements.
Responsible for contracting on case work and updating internal databases.
Coordinate with Proposal Unit for accurate and timely RFP completion.
Enforce adherence to Underwriting Guidelines and approve exceptions.
Identify and implement process improvements.
Participate in project work with other departments.
Maintain a high level of service to sales representatives and clients.
Monitor PBM and pharmacy market trends, competitor pricing, and regulatory changes.
Manage and maintain operational aspects of network programs, including project planning, implementation, cross-functional coordination, program management, data maintenance, issue resolution, and inquiry response.
Develop and deliver communications and training materials, including network management representative training, provider correspondence, webinars, and presentation materials.
Coordinate results reporting and analysis.
Perform system testing.
Coordinate with HCSC plans to support network programs and serve as plan lead.
Establish relationships with HCSC representatives and coordinate operational activities.
Participate in BCA and/or external entities meetings.
Identify and implement continuous improvement opportunities.