Fully Insured: Project COHC and set premium rates, identify/mitigate risk selection, set contribution structure for stable/favorable risk distribution, project/account for migration/enrollment/risk mix, and account for competitor and BSC provider contracts and it's impact to projected COHC.
Self Funded: price administration (ASO and Shared Advantage), medical management, blue card, and various HCQA/value add optional services. Access and price stop loss, ISL and ASL, which includes COHC projections, terms, lasers, product features to customize coverage and structure risk, and final binding process.
Underwriters directly contribute to the company achieving its financial and strategic goals. As the financial professionals who identify, evaluate and price risk, Blue Shield of CA underwriters are responsible for driving sustainable profitable growth, balancing membership and operating income.
Ensures day-to-day work flow procedures, assignments, guidelines and quality improvement measures are effectively executed by team/unit. Reviews and analyzes the competitor ratings, pricing practices and assesses the appropriateness of pricing positions.
Ensures appropriate actuarial factors and rating methods are followed to determine accurate exposure to Blue Shield CA's products.
Reviews the completion of quotes, bid specifications, benefit design strategies and financial alternatives.
Ensures underwriters work closely with the sales teams in developing proposed rating positions and benefit offering strategies as well as participates in discussions, negotiation and relationship building with brokers, consultants, agents and/or employers.
Participates on cross-functional and special project teams developing and implementing new processes and methods. Participates in Management Review sessions on new business quotes and renewals.
Other duties as assigned.
Understands basic management approaches such as work scheduling, prioritizing, coaching and process execution, work organization, risk management and delegation.
Understands Blue Shield of CA's mission and business plan.
Has functional expertise within the area of responsibility.
Typically, requires advanced knowledge of job area usually obtained through advanced education combined with experience.
Typically, requires a college degree or equivalent experience and minimum 7 years prior relevant experience, including 3 years of management experience gained as a team leader, supervisor or project/program manager.
Generally, requires eight years of relevant underwriting experience in healthcare and one to two years of supervisory experience leading a work or cross functional underwriting team.
Requires a BA/BS in a related field such as Finance, Mathematics or Accounting and/or equivalent combination of education and experience. Graduate degree (e.g. MBA) is highly desirable.
Comprehensive knowledge of medical underwriting rating principles, funding arrangements, Blue Shield CA's business drivers and broker/employer sales operations.
Advanced knowledge of healthcare industry, products and business cycles/trends.
Excellent math or statistic skills with good judgment and attention to detail.
Blue Shield Of California