JOB SUMMARY

We are seeking a highly skilled and detail-oriented Senior Underwriter with strong expertise in Administrative Services Only (ASO), Stop Loss, and pharmacy risk evaluation to join our dynamic team. This role is critical in evaluating risk, pricing strategies, and ensuring sustainable growth across our self-funded product lines.

EDUCATION

Associate’s Degree- (Required)

EXPERIENCE

Minimum of 7 years-Related work experience (Required)

Calculates premium rate proposals and develops product portfolios for new client groups and renewal business. Contributes to the achievement of the financial and marketing objectives for the thorough assessment of group risk, the expected cost to deliver services, the expected marketability and competitiveness of health care services that will result in profitable enrollment. Uses actuarial data in standard application of various rating methodologies and formulas and identifies potential areas for application of underwriting judgment. Confers with management to identify and develop methods and procedures to obtain greater efficiency. Provides support to Management relative to financial forecasting, profitability and expense analysis, and assigned special projects.

• Coordinates the Group Information Card (GIC) process for the underwriting department.
• Contacts and follows up with the sales representative for outstanding GIC’s or notices.
• Audits GICs for accuracy for first QA process Maintain GIC statistics for peak season meetings.
• Organizes Group Terminations and maintains relevant information, such as members, medical loss ratio and reason for termination.
• Prepares files for scanning.
• Acts as liaison between Underwriting and Corporate Imaging.
• Implements and maintains the records management program by complying with policy and procedures established for consistent use, maintenance, retention, preservation and destruction of Health Plan records Randomly selects files for departmental audits.
• Gathers files for the managers to audit.
• Makes sure essential information is in the file.
• Gathers information for Model Audit Rule Audits and coordinates the responses to internal audits.
• Processes and triages Medicare Supplement applications and complete auto denial applications.

Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.