Rating and Underwriting Manager at BCBSM
Posted in Insurance 30+ days ago.
This job brought to you by eQuest
Location: Detroit, Michigan
Responsible to plan, organize, direct and lead strategic analysis assignments given by leadership to achieve "Best-in-Class" analysis support to our business partners, Health Plan Business, Senior Health Services, and Health Care Value to better improve service to customers and create an environment focused on providing consultative support.
Evaluate and assess risks to safeguard the financial assets of the company.
- Provide consultative analysis on BCBSM's value proposition (how our products add value to the customer) to internal & external stakeholders and partner with the business segments to meet corporate underwriting financial goals and associated P&L objectives.
- Lead, facilitate, direct and coordinate the production of renewal rates or new business proposals, cost estimates for benefit modifications and various coordinating reports. Manage and communicate results of renewal and quote adequacy monthly meetings.
- Assess, approve, reject or make recommendations for complex underwriting rating policy exception requests taking into consideration financial and operational impact.
- Initiate and maintain appropriate rating and underwriting policies, procedures, systems, documentation and audit readiness to comply with state and federal requirements.
- Ensure application of underwriting practices and processes including risk management, differences in insured vs ASC programs, managing stop-loss, demographic rating vs claims rating.
- Maintain knowledge of systems and cross corporate workflows to ensure all processes for the team are completed with an end-to-end view.
- Manage and/or enhance reporting capabilities for financial forecasting, membership and performance metric reporting. Responsible for presenting department and divisional impacts of financials / membership results to internal and external stakeholders.
- Use judgment to recommend actions related to talent such as: interview, hire, orient, train, performance evaluation, feedback, coach, discipline and develop.
- Develop short and long-term goals to realize corporate, divisional and departmental objectives. Participate and lead project work in support of the business strategy.
- Other duties as assigned.
- Bachelor's Degree in Mathematics, Statistics, Finance, Accounting, Economics, or related field required. Master's Degree preferred.
- Six (6) years experience in rating/underwriting or related field with two (2) years at a Senior Underwriter or leadership level.
- Experience with: actuarial and group insurance principles, health care benefits and claims processing procedures, rating formulas, self funded and alternative financial arrangements, and the systems and mainframe applications.
- Ability to participate in multifunctional workgroups as SME or Business Lead
- Ability to analyze financial data, draw valid conclusions, suggest reasonable solutions and prepare summary reports required.
- Strong understanding of mathematics principals and their practical applications required.
- Excellent verbal and written communication skills required including the ability to present to executive leadership and external customers.
- Ability to function independently under minimal supervision adjusting effectively to changes in work and keeping an open mind to new and better ways of accomplishing results.
- Knowledge of Microsoft Excel, Word and Powerpoint required.MS Access & Visual Basic required.
- Ability to maintain knowledge of Federal and State laws and regulations related to health care delivery systems (HMO, PPO, ACO, etc.) and sales distribution channels required.
- Good organizational and time management skills with an ability to handle multiple tasks.
- Strong understanding of national & local competitive landscape and apply it to rating decisions and consultative analysis.