Rating Analyst I

at  CAPITAL BLUE CROSS

Position Description:
At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.”
The position provides support to the Underwriting (UW), Actuarial, Enrollment & Billing (E&B), IT&D Product, and Sales departments by reviewing and processing post sale and internal change documentation. This function assures that accuracy of the rates, which are subsequently billed to our group customers as well as protects the integrity of data housed on the enrollment system for future actuarial reporting purposes. This is accomplished through researching internal administrative policies, contractual stipulations, enrollment system requirements, and rating methodology knowledge. The quality checking process includes all product lines marketed by Capital. This procedure is performed for all sales paperwork pertaining to new groups, renewing groups, and changes to existing groups (e.g. benefit changes, hierarchy changes, rate changes, etc.).
Responsibilities and Qualifications:
Review sales paperwork documents for completeness and accuracy (i.e., all groups involved are included, valid rates, appropriate plan IDs, group numbers, etc.). Identify coding and/or entry problems and participate in problem resolution. Make necessary contacts to clarify/obtain missing or incorrect data. Analyze financial data and coverage specifics from SSRs/OTs to ensure information is complete and accurate. This process also includes the comparison of sales paperwork to the actual quote presented, and subsequently sold to the group customer. Utilize UW files and rates on sales documents to prepare documentation for loading and terminating rates on Facets. Obtain break-out rates as required from the UW files. Work with UW and Sales to receive additional rate information when necessary.
Review group benefit information to determine, if necessary, documentation is in place and there is proper coordination with rates. This requires differentiating between standard and non-standard benefits and working knowledge of benefit approval process. Review group structure and eligibility information to determine compliance with various systems capabilities. Work with other operational areas (i.e. Product, E&B) to determine group structure or troubleshoot problems as necessary. Review accounting category and rating type information on SSR/OT documents, making all appropriate corrections required. Utilize this information to assign PDBLs and Premium Indicators which are necessary in the formation of the “product” developed by IT&D Product.
Meet required processing timelines to ensure the delivery of data required to accomplish the timely enrollment process for claims, ID card issuance, and billing. Maintain documentation concerning tasks performed and maintain manual logs of production. Update StepWise to communicate all sold and/or rejected products and quotes to Rating.
Provide problem solving support to Plan personnel (i.e., Finance, Actuarial, UW, IT&D, Sales, E&B, and other internal departments). Address group setup questions, system related questions/problems, and billing errors. Analyze error reports and determine issue and resolution. Evaluate and monitor error patterns occurring in other areas and suggest corrective action measures to management. Identify need for Facets testing on necessary changes if the end result is unknown as it applies to underwriting areas within the system. Facilitate and complete Facets testing as necessary. Respond to all inquiries via telephone, e-mail, etc., in a timely and accurate manner.
Utilize reports to quality check group set-up and rate information in Facets after the group enrollment process is completed by E&B.
Recommend and document procedural changes. Maintain up-to-date procedure manual. Maintain a working log of available group specific hierarchy.
Participate in yearly Individual Account project meetings. Participate in special projects (i.e., clean-up, developmental, changes, etc.) with other areas as assigned.

SKILLS:

• Ability to sustain a high level of accuracy throughout a process involving detailed information.
• Ability to analyze processes to effectively document and communicate procedures.
• Ability to participate in project work, including the ability to communicate in writing and verbally with both technical and non-technical audiences. Also includes persuasion and negation skills.
• Ability to perform duties with minimal supervision. Includes ability to act both independently and as part of a team as well as the ability to adapt to changing priorities.
• Ability to prioritize workload during normal and peal processing periods.
• Ability to create solid working relationships with other internal areas of the company and associated vendors.

KNOWLEDGE:

• Working knowledge of Stepwise, Facets or MARIS systems.
• Knowledge of rating structures of all product lines sold by Capital Blue Cross (Capital), include Large and NonLarge, Commercial and Medicare, group and individual, consortiums and CHIP.
• Working knowledge of Non-Large benefit and rate changes and how coding changes affect various internal systems.
• Familiar with Capital renewal and quote processes as well as related financial arrangements.
• Familiar with Capital corporate structure to facilitate outreach.
• Working knowledge of accounting categories and ability to identify needs for additional account categories or PDBLs.

EXPERIENCE:

• Proficiency in the use of laptop software and end user computing tools (e.g., Windows, Microsoft Word, Excel, Outlook and Teams) and general office equipment such as a calculator.

EDUCATION, CERTIFICATION AND LICENSES:

• High school diploma or GED.
• Advanced degree or the equivalent of 3 years working experience in a related health insurance industry field is preferred.
  About Us: We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a diverse and caring team of supportive colleagues, and be encouraged to volunteer in your community. We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career. And by doing your best, you’ll help us live our mission of improving the health and well-being of our members and the communities in which they live

Please refer the Job description for details