Develop underwriting policy and procedures based on regulatory changes. Keep informed on changes and communicate policy/procedure changes to impacted stakeholders such as Billing, Claims, Sales, and others. May have leadership responsibilities for direct reports.
- Review, analyze and interpret DIFS and CMS regulations to ensure group and individual business compliance. Communicate changes to impacted stakeholders and develop policies and procedures that comply with the regulations.
- Perform compliance assessment & audits of actuarial and underwriting policies and procedures, identify risks, recommend solutions and support corporate compliance and audit processes. Collaborate with internal business areas to implement cross divisional projects and initiatives. Assist in the creation of new processes to resolve issues. Perform QHP attestations and review of applications for qualifying events from any third party that processes applications on behalf of BCBSM and BCN. Respond to inquiries from DIFS, Executive Services, Billing and Customer Service.
- Develop and maintain effective working relationships with customers and business partners. Interact with agents, applicants, sales and various internal/external entities to help determine eligibility and communicate decisions, guidelines and policies. Assist management with the implementation of solutions, attend meetings and support cross divisional projects and initiatives.
- May lead team providing, performance feedback, team building, change management and conflict resolution.
- Utilize various data sources to validate eligibility and maintain in-depth knowledge of corporate business, products, programs, systems (claims, reimbursement, benefits, and providers), medical terminology and insurance laws.
- Other duties as assigned.
- Bachelor's Degree with a major in Finance, Accounting, Business Administration, Economics, Mathematics, Statistics or in related field required.
- Five (5) years of underwriting experience with at least two (2) years experience in a leadership role preferred.
- Experience working with health insurance membership and claims systems.
- Ability to analyze financial data, draw valid conclusions, suggest reasonable solutions and prepare summary reports required.
- Extensive knowledge and understanding of underwriting decision process, medical terminology, medical record review, underwriting policies and rating methodologies for group and individual health insurance policies, health insurance benefit administration required.
- Demonstrated excellent interpersonal, verbal and written communication skills which are required for interaction with regulatory agencies and other areas of the company.
- High level of proficiency using existing software packages (Microsoft Excel, Word, PowerPoint, Outlook, SharePoint, etc.)
- Knowledge of federal and state regulations that impact group and individual insurance.
- Knowledge of actuarial and group insurance principles, health care benefits and claims processing procedures.
- Ability to work effectively in a team environment.
- Ability to multi-task and prioritize work assignments.
- Other related skills and/or abilities may be required to perform this job