Associate Medical Stop Loss Underwriter

Company: Highmark Health
Location: Washington
Posted on: March 29, 2025

Job Description:

Thank you for your interest in employment at a Highmark Health company. Highmark Health uses an online application process. If you participate in the online application process through this Workday site, your personal information will be collected, including but not limited to data such as your resume and resume content, education, contact information, address, city, postal code, country, phone number, email address, IP address, as well as any other personal information you choose to provide. As part of the online application process, we will provide details such as how we will use the data that we collect and where such information is processed. We will also ask for your consent to use the data for purposes contained in the Highmark Health Data Protection Statement and the GDPR Data Protection Consent for Job Applicants, and for all other permissible purposes.Associate Medical Stop Loss UnderwriterCompany: HM Insurance GroupJob Description:JOB SUMMARYThis job prices quotes and analyzes the structure of a contract for a group based on claims experience, characteristics of the employee groups, etc. The incumbent develops and uses discretion of Underwriting authority, within the policies of HMIG, and ensures appropriate levels of profitability and growth over time. Identifying when to decline quotes that do not fit into the overall HMIG strategy and risk structure. Analyzes risk factors for new enrollment, annual renewals, and amendments of group insurance contracts or of self-funded plans in conformance with established underwriting policies, practices, and standards. Analyzes associated policies, guidelines, market data to continuously improve risk management and gain appropriate enrollment or manage existing membership. Analyzes data such as financial conditions of the organization, participation percentage, type of industry, characteristics of employee groups, or past claim experience to determine what benefits can be offered and to set the rates. Prepares a variety of reports and provides rationale and support to other areas within the organization, clients, and possibly producers regarding one or more of the following: underwriting results, rate computations and financial activity. Provides expense estimates and accurate analysis of financial exhibits. This is an entry-level position, with oversight by Senior Underwriters and/or Management until the individual is acclimated to the Company procedures, policies, and protocols.ESSENTIAL RESPONSIBILITIES

• Responsible for a book of business of renewing accounts and writing new business at profitable levels to help HMIG achieve overall business targets/or assigned volume of new applications or RFPs. Utilizes various systems and tools to obtain necessary data and accurately complete and track assigned work. Receives guidance and technical oversight from other staff members.
• Review and complete Rating and Analysis work with guidance and technical oversight from other staff.
• Calculate rates, employ different financial arrangements, interpret pricing policy and adapt to unusual situations.
• Identify questionable claim patterns of renewal clients and issues with competitor's claims experience for prospect clients and develop recommendations to account for these situations.
• Apply corporate risk management policies and adjust for unusual situations that may not have been considered in the standard pricing formula.
• Identify when clients do not comply with corporate risk management policies, disclosure rules, or conditions/criteria for enrollment.
• Recommend appropriate adaptation of pricing within the appropriate policy/guideline to accommodate each client specific or individual situation.
• Analyze member risk and engage internal departments to manage this risk.
• Support other internal initiatives which may include but not be limited to fraud detection, corporate compliance, wellness/disease management, and product development efforts.
• Complete renewals, prospect quotes, in accordance with production and timeliness standards.
• Adapt to changing priorities as quotes come in from different markets and adapt to new priorities and requirements.
• Communicate recommendations of policy adaptation to accommodate client-specific situations supported by a clear rationale or management principles.
• Influence sales and external audiences toward appropriate risk solutions.
• Influence sales team towards the appropriate pricing and structure of each quote.
• Other duties as assigned or requested.EDUCATIONRequired
  • Bachelor's Degree - Mathematics, Actuarial Science, Finance, Business, Computer Science or other quantitative analysis disciplineSubstitutions
    • 6 years relevant, progressive experience in the area of specializationPreferred
      • NoneEXPERIENCEMinimum
        • 0 - 2 years of experience in Insurance, Underwriting of Self-Funded and/or fully insured prospects preferredPreferred:
          • NoneSKILLS
            • Developing understanding and knowledge of various internal departments and external stakeholder interactions
            • Ability to use applicable computer systems, electronic tools and applications
            • Ability to work independently and assume responsibility for routine projects
            • Demonstrate an understanding and support of corporate and departmental goals and initiatives
            • Demonstrate ethical business practices with adherence to all privacy and confidentiality policies and regulations
            • Good problem-solving, organizational, and negotiation skills required
            • Excellent math aptitude required to complete analysisREQUIRED LICENSURE
              • NonePREFERRED LICENSURE
                • Actively pursuing a professional designation related to the healthcare industry and be willing to complete one course within twelve months in either Life Office Management Association (LOMA) Certified Employee Benefit Specialist (CEBS), or America's Health Insurance Plans (AHIP)TRAVEL REQUIREMENT0% - 25%Language (Other than English):NoneTravel Requirement:0% - 25%PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONSPosition TypeOffice-basedTeaches / trains others regularlyOccasionallyTravel regularly from the office to various work sites or from site-to-siteRarelyWorks primarily out-of-the office selling products/services (sales employees)NeverPhysical work site requiredYesLifting: up to 10 poundsConstantlyLifting: 10 to 25 poundsOccasionallyLifting: 25 to 50 poundsRarelyDisclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.Pay Range Minimum: $22.71Pay Range Maximum: $35.18Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org
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Keywords: Highmark Health, Washington DC , Associate Medical Stop Loss Underwriter, Healthcare , Washington, DC