Summary:

* Participate in managing the financial risk of EmblemHealth through complex underwriting of various businesses.

* Underwrite existing medical and dental accounts, including Broker, Commercial and Labor and Government accounts, within published time frames.

* Prepare employer reports and provides analysis for use in accessing level of risk and in consulting with clients (brokers and consultants) regarding benefits, product design, financial arrangements and general utilization trends.

* Underwrite new business portfolio which may include Small Group, Large Group Experience Labor and Government,Commercial, Self-Insured (depending on specific state - NY or CT), Large Group Community Rated accounts.

* Advise the Underwriters in the Underwriting Leader's absence.

* Support the department in the development of good working relationships between Underwriting and Account Management.

* Assume responsibility for entry level training program and supporting new hire underwritings.

* Support Organizational/Underwriting Initiatives, including improvements to tools used by Underwriting.

Responsibilities:

* May underwrite new/existing large and/or small groups, within the published departmental time frames, and using the departmental and corporate guidelines, strategies, and goals.

* Calculate fully insured and self-funded quotes and renewal rates for all case sizes for both manually rated and experienced rated accounts based on sound underwriting principals.

* Ensure that established yield and membership targets are met; alert Director for potential problems and opportunities.

* Apply knowledge to evaluate and analyze accounts to recommend coverage, policy terms and conditions to obtain and renew quality, profitable desired business.

* Effectively communicate proposed pricing, coverages and rating plans to brokers. Provide clear documentation and recommendations to management, update tracking tools.

* Evaluate risk using demographics, claims experience, predictive modeling, high-cost claimant review, and other criteria.

* Utilize various pricing models to develop both manual and experience rates.

* Evaluate pricing impact of alternative plan designs.

* Collect data and produce enrollment, claims, utilization reports from COGNOS, Tableau, Facets, and other databases/reporting tools.

* Prepare summaries for Account Executives for renewals, based on financial history of the groups, demographics and projections moving forward.

* May be responsible for preparing reports to track risks and profitability; forecasting earned premium and provide routine updates and reconciliations.

* Communicate and explain Underwriting recommendations/decisions to the Sales Account Executives.

* Provide support explaining analysis to brokers and/or customers as needed.

* Attend client presentations to respond to and answer underwriting/financial questions.

* Support sales area in a consultative capacity with regard to underwriting and product information with a view to overall business enhancement.

* Lead Organizational/Underwriting initiatives.

* Serve as technical resource and mentor for lower-level Underwriters.

* Review and analyze Request for Proposals (RFPs) and prospective rate quotes from Brokers, Consultants, and Marketing Representatives.

* Prepare financial exhibits and answers Underwriting questions for Sales Representatives.

* Perform other related projects and duties as assigned providing professional, pro-active input as needed.

* Maintain industry level knowledge of trends, practices, digital design software, etc.

Requirements:

* Bachelor's degree (preferably in Mathematics, Economics, Statistics, Finance, Healthcare Mgmt., or Business Administration) required

* 4 - 6 years of Group Health Insurance Underwriting experience required

* Underwriting experience, preferably in a managed care environment with both fully insured and self-funded experience required

* Knowledge of underwriting methodologies, especially Experience Rating Methodology required

* Excellent attention to detail; quantitative, analytical, critical thinking, and decision-making skills required

* Proficient in MS Office (Word, Excel, Access, PowerPoint, Outlook, Teams, etc.) required

* Strong technical underwriting and math skills required

* Ability to make sound logical independent decisions required

* Ability to successfully manage multiple tasks/projects with simultaneous competing priorities and deadline required

* Results-oriented with the ability to function in a fast-paced dynamic environment required

* Excellent organizational and prioritizing, skills; proven ability to successfully manage multiple simultaneous priorities required

* Strong communication skills (verbal, written, presentation, interpersonal, negotiation) required

* Willingness to work with Sales and make compromises to renew existing accounts and sell new business required

* Ability to negotiate with brokers/consultants required

Additional Information

* Requisition ID: 1000001767

* Hiring Range: $63,000-$110,000