Director, Shared Savings & Revenue Optimization (Hybrid)

Resp & Qualifications

PURPOSE:
Accomplishes Insurance Underwriting Objectives by determining new service requirements; settling exceptions and appeals; negotiating special reinsurance arrangements; enforcing adherence to internal and external underwriting policies, procedures, guidelines, and regulations; reviewing risk acceptability; evaluating loss history; evaluating product results; setting training objectives; directing staff.

ESSENTIAL FUNCTIONS:

• Directs insurance underwriting  strategies by determining accountabilities; communicating and enforcing values, policies, and procedures; implementing recruitment, selection, orientation, training, coaching, counseling, disciplinary, and communication programs; planning, monitoring, appraising, and reviewing job contributions; reviewing compensation strategies. Determines new insurance underwriting service requirements by conducting surveys; forming focus groups; analyzing information and applications.
• Responsible for insurance underwriting organizational, financial and operational strategies by contributing information, analysis, and recommendations to strategic thinking and direction; establishing functional objectives in line with organization goals; analyzing trends; preparing critical measurements; implementing production, productivity, quality, customer-service, safety, security, and health strategies; leading system improvements; anticipating requirements, trends, and variances; developing action plans; measuring and analyzing results; initiating corrective actions; minimizing the impact of variances.
• Completes insurance underwriting by settling exceptions and appeals; negotiating special reinsurance arrangements; enforcing adherence to internal and external underwriting policies, procedures, guidelines, and regulations; reviewing risk acceptability; evaluating loss history. Settles insurance problem escalations by evaluating file documentation. Improves product profitability by evaluating product results.
• Ensures legal compliance by auditing and enforcing guidelines, account contracts, and company business plan; verifying implementation of State-mandated regulations and required forms and rates; approving documents for State filings, and marketing materials.
• Protects organization value by keeping information confidential; cautioning others regarding potential breaches. Improves insurance underwriting services management job knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; benchmarking state-of-the-art practices; participating in professional societies.
• Maximize the potential savings generated by each Payment Integrity and Shared Savings programs through greater employer adoption and increased effectivity, both operationally and financially.
• Work in a matrixed environment to encourage all areas within the organization to contribute to the success of the programs.
• Identify new programs and work with all key stakeholders to execute the program from concept to the go-to-market strategy.
• Represent CareFirst BCBS at BCBSA and Industry functions to keep current on new programs and ideas.
• Work closely with the colleagues within Finance to project future revenue possibilities.
• Work closely with your peers within underwriting to establish the appropriate billing practices.
• Effectively communicate the value of the programs to the organization and external constituents.  

SUPERVISORY RESPONSIBILITY:
This position manages people.

QUALIFICATIONS:

Education Level: Bachelor's Degree OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.

Licenses/Certifications:

• Associate in Personal Insurance, Commercial Underwriter
• Chartered Property Casualty Underwriter (CPCU)  Upon Hire

Experience: 8 years progressive experience underwriting experience in group health, medical, ancillary and/or pharmacy. 3 years management experience.

Knowledge, Skills and Abilities (KSAs)

• Strong knowledge of insurance underwriting methods and procedures.
• Excellent communication skills both written and verbal.
• Strong knowledge of property coverage, risk hazards, and policy forms.
• Ability to maintain effective interpersonal relationships.
• Knowledge of compensation insurance; rules, classifications, statues, and rates.
• Ability to apply underwriting methods to create comprehensive reports.
• Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

Salary Range: $142,160 - $263,885

Salary Range Disclaimer

Salary will be based on education, location, experience, certifications, etc. In addition to your salary, CareFirst offers benefits such as a comprehensive benefits package, incentive and recognition programs, and 401k contribution (all benefits are subject to eligibility requirements).

Department

Department: 51 Pls New Business

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer.  It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Federal Disc/Physical Demand

Note:  The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position.  Occasional walking or standing is required.  The hands are regularly used to write, type, key and handle or feel small controls and objects.  The associate must frequently talk and hear.  Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

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