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Blue Cross Blue Shield of Michigan Rating and Underwriting Consultant in Detroit, Michigan

Description

Evaluate and assess risks to safeguard the financial assets of the company. Coordinate and direct highly complex and specialized Underwriting projects, which have significant impact on the company’s financial position and other functional areas. Responsible for financial soundness of rates and prices for a significant line of business.

  • 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, 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.
  • Proactively seek out opportunities to develop new systems, solutions, enhancements to better manage reporting capabilities for financial forecasting, membership and performance metric reporting.
  • Independently communicate rating and underwriting issues, solutions, risks, implications, impacts of financials / membership results and recommendations on behalf of the department and division to team members, senior leadership, internal and external stakeholders.
  • Lead, plan and deliver projects utilizing project management methodology to enhance systems, business processes, procedures and reporting, coordinating across departments and divisions. Act as a technical resource and subject matter expert to address or resolve underwriting and healthcare issues across the enterprise and review work of peers for underwriting accuracy and compliance representing the organization on industry task forces and work groups when necessary.
  • Other duties as assigned.
Qualifications
  • 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.
  • 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

All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability.

Job: Underwriting

Primary Location: Detroit

Organization: Underwriting & Actuarial Trend-1122

Schedule: Full-time

Req ID: KEY0005W

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