Lead Underwriter (managed care/healthcare)

Summary :

• Lead and provide training to the Underwriting team on all aspects of Underwriting which includes pricing strategies and setting conditions to protect EmblemHealth against financial loss.
• Responsible for a portfolio of complex accounts to ensure the goals and profitability objectives are met.
• Work closely with Sales / Account Management and provide financial consultation on rate renewals and plan changes.
• Responsible for updating, maintaining, and providing aggregated UW results to senior management, and for providing recommendations for pricing strategies.
• Responsibilities are for the City of New York (CNY) account.

Responsibilities :

• Responsible for rate renewal development, new business rate quotations, respond to RFP’s, Prospective Plan Summaries and Statements of Experiences.
• Provide analytical observations and recommendations to department leadership for outlier outcomes.
• Track margin levels compared to budget and re-forecasted numbers, explaining variances as needed and reporting monthly to Director of Underwriting on results.
• Participate in and / or lead various projects such as new product development, cost control initiatives, reporting, underwriting systems development and rating methodologies.
• Identify inefficiencies, develop process fixes and implement new solutions for both internal / external use.
• Utilize a variety of analytics to proactively make decisions and support problem solving.
• Utilize information to perform reasonability and accuracy checks.
• Ensure underwriting actions are coordinated with all appropriate departments (e.g., Account Management / Sales, Product, Group Admin, etc.).
• Utilize underwriting models develop fully insured and self-funded quotes and renewal rates for large case sizes for both community rated and experienced rated accounts.
• Ensure that the established yield and membership targets are met, alerting leadership for potential problems and

opportunities.

• Develop creative group medical pricing strategies, propose alternative products, and negotiate prices with customers and their consultants, in a consultative capacity.
• Provide analysis for use in assessing level of risk and in consulting with clients (brokers and consultants) regarding benefits, product design, financial arrangements, high-cost claimants, and general utilization trends;

closely monitoring the impact of business decisions and strategies.

• Clearly communicate and explain financial underwriting reports, strategy, and provide backup to support recommendation and decisions.
• Assess risk associated with recommendations and those of direct reports.
• Develop supporting plans based on presentation of clear strategies.
• Participate actively in account renewal and finalist presentations to existing and prospective accounts, brokers, and consultants, working with brokers, consultants, and clients to respond to financial questions as needed.
• Assess and communicate how / if to proceed with new business opportunities and renewals, based on quality of prospect, data, and any other information for all products including fully insured and all self-funded products.
• Serve as point of contact and subject matter expert for audits (internal, DFS, customer, etc.); produce quality responses to audit requests.
• Maintain a limited book of business in addition to back-up for other groups.
• Serve as a delegate / representative when the director is unavailable.
• Provide large group underwriting staff with periodic updates to rating factors and methodologies to ensure use of consistent practices from all Underwriters.
• Promote a self-managed work team providing training and technical support.
• Empower staff to make decisions and motivates staff to work efficiently.
• Develop and maintain new hire training; support and lead training initiatives within the Underwriting department, as well as with other teams (e.

g., Account Management team).

• Review the work of others; provide support to others as needed for complex accounts; provide recommendations for alternate approaches.
• Assess associates’ work, providing feedback and recommendations for areas of improvement. Participate in performance reviews and feedback as appropriate.
• Educate staff needing assistance regarding underwriting and lead cross functional teams addressing opportunities to include underwriting function.
• Guide underwriters, associates and interns as they take on new responsibilities.
• Build and maintain positive work culture that support the corporate values and goals.
• Mentor junior staff and peers to help in their growth and development.
• Analyze enrollment, premium and high claim reports on existing business cases. Observe irregularities in the data and initiate an investigation.
• Develop group-specific applications, including historical trends, cash flow analyses, advance deposit calculations for ASO banking arrangements, reserves for claims incurred but not yet reported or paid, provider fee schedule reimbursement comparisons, and catastrophic claim analysis.
• Responsible for the preparation of periodic analyses and forecast of underwriting results on a group specific basis for review by Management.
• Review Actuarial variables included in rating formulas and underwriting guidelines as established by the Actuarial Department.
• Coordinate with other corporate departments to ensure the accuracy and consistency of data reporting.
• Maintain production standards to support Departmental goals and ensure compliance with Sarbanes-Oxley initiatives.
• Perform other related group underwriting duties as assigned or required.

Requirements :

• Bachelor’s degree in Mathematics, Finance, Statistics, or related field required
• Master’s Degree in Business, Finance, or health care preferred
• 5 8+ years of Underwriting experience as a Senior Underwriter, Consulting Underwriter, or other supervisory role required
• Working knowledge of underwriting principles and techniques required
• Extensive knowledge of health benefits programs and financial arrangements from both a risk and cash flow aspect required
• Solid experience in underwriting 1,000+ lives group medical plans, including the development of account specific rating formulas, trend analysis, claim lag studies, methods for identifying and controlling adverse selection, employee contribution strategies, etc. required
• Excellent quantitative and analytical skills required
• Advanced computer skills and proficiency with Microsoft Office (Word, Excel, PowerPoint, Outlook, Teams) required
• Excellent communication (written, oral and presentation) skills required
• Proven negotiation skills required
• Proficiency with spreadsheet, database, and network technology required
30+ days ago