Underwriting Quality and Tools Analyst

Blue Cross and Blue Shield of Kansas•Topeka, IN

1d•Hybrid

About The Position

The Underwriting Quality & Tools Analyst ensures the accuracy, efficiency, financial integrity, and continuous improvement of underwriting processes, rating methodologies, and actuarial evaluations supporting group rating and stop-loss analysis. This role focuses on quality assurance, underwriting governance, actuarial support, process optimization, reporting, tool maintenance, and training to support underwriting operations. The analyst leads quality reviews, manages actuarial and underwriting data integrity, evaluates rating methodologies, refines risk assessment tools, assists in system improvements, and collaborates with internal stakeholders to enhance efficiency and compliance. Reporting to the Manager, Underwriting Quality & Tool, this role plays a key part in driving data integrity, automation, and workflow enhancements.

Requirements

Bachelor's degree in Business, Mathematics, Statistics, Finance, or a related field required.
Minimum of 3 years of experience in underwriting, group rating, actuarial, sales, or quality assurance within the health insurance industry required.
Strong analytical and problem-solving skills to assess underwriting data, quality trends, actuarial trends, risk factors, and process inefficiencies.
Expertise in quality assurance methodologies and underwriting rating tools.
Ability to develop and deliver technical training programs and create comprehensive documentation for underwriting processes.
Knowledge of actuarial and underwriting principles, rating methodologies, and health insurance regulatory compliance.
Strong organizational skills with the ability to manage multiple tasks and deadlines efficiently.
Proficiency in reporting, database management, and underwriting system tools.
Excellent communication and collaboration skills to work effectively with actuarial and underwriting teams, auditors, and regulatory bodies.
Experience with rate filings (SERFF) and regulatory compliance reporting.

Nice To Haves

Experience in reporting, process improvement, and automation of underwriting workflows preferred.
Background in regulatory compliance, rating factors, and underwriting system administration is a plus.

Responsibilities

Oversee and execute quality reviews of Group Rating Intake Tool (GRIT) requests and monthly production work, ensuring accuracy and compliance with actuarial rating methodologies and underwriting guidelines.
Conduct actuarial, underwriting, and financial impact analysis, including short/long stop-loss period analysis, credibility studies, and underwriting risk assessments to drive data-backed recommendations.
Develop and implement training materials, procedure manuals, and departmental documentation to ensure standardization and knowledge retention of actuarial methodologies and underwriting practices.
Identify and implement efficiencies in underwriting workflows, leveraging automation, predictive modeling, and data-driven process improvements to optimize team productivity.
Develop and deliver technical training on underwriting practices, actuarial methodologies, rating factor adjustments, and risk evaluation techniques.
Collaborate with internal and external audit teams to support actuarial and underwriting compliance, quality controls, and regulatory reporting.
Review and validate with final quality reviews for monthly mailings and other underwriting communications to ensure accuracy and clarity.
Develop, analyze, and maintain rating factors and risk models that support underwriting and actuarial tools, ensuring data-driven decision-making.
Support SERFF rate filings with the Kansas Department of Insurance (KDOI) ensuring accurate and timely submission of rate justifications and regulatory documents.
Oversee enhancements to underwriting tools and actuarial databases, ensuring seamless integration of rating models and optimization of underwriting systems.