Job SummaryResponsible for underwriting new and renewal medical stop loss business which includes reviewing, evaluating, selecting, and rating each risk to maximize premium revenue while meeting enterprise profit margins and production goals. Responsible for any other applicable products that require and allow underwriting of risk.
Essential Functions- All team members are expected to be knowledgeable and compliant with Prisma Health's purpose: Inspire health. Serve with compassion. Be the difference.
- Responsible for the development, implementation, and maintenance of underwriting programs, policies, procedures, and guidelines to ensure compliance and profitability.
- Reviews Group health insurance applications and medical records to evaluate risk. Uses underwriting software, A.I. tools and actuarial manuals to calculate rates, premiums, and factors. Performs detailed pricing analysis and contribute to pricing strategies to optimize profitability.
- Reviews stoploss offers and makes recommendations to the sales team on which stoploss offer to use when building Promise Health Plan proposals, based on pricing and contract terms
- Creates and updates financial models for forecasting and budgeting. Conducts analyses to identify key metrics for modeling financial data (revenue, cost, expenses, KPIs). Compiles data on yearly loss ratios and medical trends for program evaluation.
- Communicates with stop-loss partners regarding risk levels and forecasted claims costs on new and renewing business.
- Consults with payer staff to obtain information, review insurance laws, and explain underwriting policies.
- Collaborates with internal teams to understand monthly trends and ensure comprehensive risk evaluation.
- Develops and maintains strong relationships with brokers, agents, and reinsurers.
- Prepares detailed reports and documentation to support health plan decisions.
- Maintains accurate records of underwriting decisions and related data.
- Ensures compliance with legal standards and stays current on industry regulations and legislative changes.
- Conducts regular audits of underwriting files to ensure quality and compliance.
- Informs enterprise payer strategy, including forecasting and approach for insurance products.
- Serves on work groups or process improvement teams to enhance quality and customer satisfaction.
- Performs other duties as assigned.
Supervisory/Management ResponsibilitiesThis is a non-management job that will report to a supervisor, manager, director, or executive.
Minimum Requirements- Education - Bachelor's degree in Business, Finance, or related field
- Experience - 7-10 years of related experience in Medical underwriting and risk assessment
In Lieu OfN/A
Required Certifications, Registrations, LicensesActive medical/health underwriting certification
Knowledge, Skills and Abilities- Knowledge of insurance principles, policies, and regulations
- Attention to detail
- Effective communication and negotiating skills, both written and verbal
- Ability to work collaboratively in a team environment
- Proficient in using underwriting software and tools
- Knowledge of underwriting self-funded and converting fully insured prospects into self-funded products
- Basic computer skills including word processing, spreadsheets, database and data entry
- Knowledge of office equipment (fax/copier)
- Mathematical skills
Work ShiftDay (United States of America)
LocationPrisma Health Corporate Office
Facility7002 Value-Based Care and Network Services
Department 
