Resp & Qualifications
This position is responsible for the oversight and direction of CareFirst and its subsidiaries underwriting processes and procedures and financials, for all 51 – 199 Underwriting operations, including but not limited to new business and renewals with the focus on enhancing profitability of the operation and increasing market share. The position will oversee the teams responsible for managing the 51 - 199 Underwriting processes, including, training, motivating, mentoring, coaching, monitoring of performance and account level guidance.
This position will work in close collaboration with CareFirst Sales, Marketing, Finance, Actuarial and SBU Leaders to shape the company’s business response to emerging market trends and the evolving regulatory environment being driven by Health Care Reform. The strategic partnerships that will be developed with the Mid and Large Group SBU’s, will create strong relationships and strategies to sell and retain profitable large group business.
This position will interact regularly with the consultant community and have direct involvement with the creation, maintenance and monitoring of 51 - 199 accounts.
This position will provide strategic direction and oversight related to healthcare reform Mid-Market underwriting and will represent the Vice President of Underwriting in internal and external meetings.
This position will be the critical liaison between CareFirst and our Ancillary Vendors providing strategic oversight and approval of the joint underwriting functions for Pharmacy, Life, Disability and Worksite Wellness benefits crossing all SBU’s and underwriting teams (Individual, Small Group, Mid Market and Large Group). In conjunction with the VP of Underwriting, the incumbent will develop annual pricing tiers for pharmacy to ensure appropriate non risk margin.
The incumbent will work with the Vice President of Underwriting to develop and oversee the budget and forecasting for Large Group.
This position is responsible for working in collaboration with the Sr. Director of UPPST to develop, implement and maintain procedures that adhere to the insurance regulations as they pertain to the Underwriting operations; and financial controls to ensure accuracy of the group account rating of insured and ASO business and ASO billings.
ESSENTIAL DUTIES AND RESPONSIBILITIES may include, but are not limited to, the following:
Duties and Responsibilities
Assess present and future needs, trends, problems and profit opportunities for the 51 - 199 line of business. Participates in the development and implementation of plans and policies establishing short/long term operating and financial objectives. Participates in operational activities including the: development of action or strategic plans for the department; participate on a variety of task forces that will develop new or augmented products and require technical expertise and representation from Underwriting.
Direct and oversee the integration with our Ancillary Vendors providing strategic oversight and approval of the joint underwriting functions for Pharmacy, Life, Disability and Worksite Wellness benefits crossing all SBU’s (Individual, Small Group, Mid Market and Large Group). Develop annual pricing tiers for pharmacy to ensure appropriate non risk margin.
Oversees the evaluation and rating of the 51 - 199 new business and renewals ensuring that all standards, policies and procedures are met to ensure financial profitability of our book of business and that workload is evenly distributed among staff. Operate within budget constraints and lead in tactical and strategic planning. Monitor overall performance of underwriting staff.
Monitor financial performance of book of business to provide advance notice of potential adverse outcomes to Underwriting VP. Prepare or oversee the accurate preparation of monthly financial reports for Senior Management. Prepare risk and non-risk forecast projections and participate in forecasting discussions.
Monitor performance of underwriting staff. Provide training support, mentoring, coaching and guidance to underwriting staff. Utilizes knowledge of products, legislation and CareFirst competitors to enhance the development and performance of underwriting associates. Monitors compliance with corporate and departmental policies.
Adjudicate appeals of underwriting decisions, review all large group underwriting exceptions relative to the rating, contract or administration of operation accounts, ensuring that departmental activities are in accordance with CareFirst policies and procedures, and that issues and appeals are resolved appropriately in a timely manner – with proper notification to the VP of Underwriting.
This position requires a minimum of eight (8) to ten (10) years of progressively responsible group underwriting experience, including both indemnity and managed care products. Individual must be extremely knowledgeable of risk evaluation and pricing and rating methodologies used within the health insurance industry and at CareFirst. Individual must have thorough knowledge of industry laws and regulations, products, benefit plan designs, market trends, ancillary benefits and alternate funding arrangements. Individual should have demonstrated experience in handling large and/or complex accounts, as well as extensive corporate knowledge. Individual must possess strong analytical skills and ability to work across functional areas. Position requires excellent written and oral communication skills, including the ability to explain complex topics clearly to diverse and potentially hostile audiences. A minimum two 10 years of prior supervisory, management or related experience leading teams or projects is required. Executive Presence is required
Bachelor's degree, in Business, Accounting, Finance or related field or equivalent experience is required.
Department: Marketing Underwriting
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.
Hire Range Disclaimer
Actual salary will be based on relevant job experience and work history.
Where To Apply
Please visit our website to apply: www.carefirst.com/careers
Please apply before: 3/13/2019
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.
The associate is primarily seated while performing the duties of this position. Occasional walking or standing is required. The hands are regularly used to write, type, key, and handle small controls and objects. The associate must frequently talk and hear. The physical demands described here are representative of those which must be met by the employee to perform the essential duties of the position. Most requirements can be modified to accommodate individuals with disabilities.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship