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This position will solicit, write, and retain a profitable book of Managed Care/Reinsurance business. Requiring extensive underwriting analysis and sound judgment, this role will be responsible for contributing to the achievement of Berkley Accident and Health’s financial plans by meeting established premium growth and profitability goals.
- Assess risk to ensure that the risk meets established underwriting criteria.
- Evaluate, price and propose rates based on established underwriting guidelines while meeting profitability standards set by management.
- Manage assigned workload to meet productivity and time service standards, ensuring that appropriate action is taken within the requested due date.
- Develop and maintain successful relationships with producer sources.
The Clinical Underwriting Nurse I or II will perform individual medical risk analysis on large claimants for proposed Traditional, Captive, and Managed Care new and renewal business. Reviews data provided by the policyholder to identify claimants with catastrophic or complex diagnoses and assess medical and claims information available to calculate potential risk.
- Assess medical risk for each identified claimant utilizing all available information and applying appropriate guidelines to meet the financial risk management goals of the company.
- Reviews detailed large claim reports from a variety of sources including trigger reports, detailed individual claim reports, pending and denied reports, case management reports, and utilization reports.
- Analyzes medical procedures codes, medication J codes, and prescription drug reports to assist in predicting the future claim costs.
- Researches rare/complicated medical conditions/treatment options using resources including the internet, nursing, clinical resource tools by state/network.
- Presents and documents a clear medical review summary with an analysis of the current clinical conditions and a future annual claim projection to the underwriter.
- Stays informed of current medical and drug trends and shares information with team members.
- Plan and develop work plans, establish timelines, and set goals for assigned work.
- Make necessary referrals to Clinical Cost Containment Services and partner with that team as needed to ensure financial risk management and clinical cost containment effective support based on their clinical needs.
- There is no management of people but will provide clinical guidance to less experienced employees.
Berkley Accident and Health is seeking a full time Stop Loss Underwriter for our Group Captive division. This position will write and retain profitable accounts that require underwriting experience, with an analytic approach to spread risk. This role will contribute to the achievement of Berkley’s financial plans by meeting premium growth and profitability of assigned book of business.
- Underwrites and proposes financial structure on accounts from 50 – 400 employees within delegated authorities that are specific to position.
- Responsible for constant analysis and development of underwriting and business guidelines.
- Develops and maintains successful relationships with target sources and assigned programs.
- Responsible for ensuring profitability at both the single employer and group captive level.
- Manages an assigned volume of case and program activity for both new and renewal policies.
- Works with Supervisor and Actuary to revise and develop group captive tools to improve efficiencies in underwriting process.
- Communicates effectively with various team members within Captive Division.
The Underwriting Assistant provides set up and administration assistance to the underwriting team. This position will report to the Underwriting set up manager and will work closely with both sales and underwriting. Organizational skills and attention to detail play a key role, as this position sets up and tracks all underwriting folders with account information.
- Set up folders in our shared drive for all information received for new submissions
- Run census in Excel spreadsheet for each submission
- Log submission in David Young system including benefits, reinsurance terms, and census
- Communicate between Sales Reps and Underwriters to ensure all information is complete and accurate
- Develop and manage trusted relationships with assigned captive programs, including effectively interfacing with C-Suite and executive level business relationships at the policyholder, TPA, Broker, Captive and a variety of third parties.
- Function as primary liaison with Captive Managers, Captive Consultants, Broker/Consultants together with business development team.
- Support business development team in relation implementation of new captive programs.
- Build relationship with distribution channels and support their efforts to build membership within captive programs.
- Deliver necessary reporting, analysis and make health risk management strategy recommendations to aide in the management of financial exposure.
- Manage and develop communications for the Captive Program (i.e. newsletters, monthly and annual loss reporting/analysis.
- Function as primary liaison with Captive Manager and oversee necessary captive deliverables to ensure timely cession reporting and member/consultant support.
- Coordination and preparation of monthly, quarterly and annual loss reporting packages, quarterly conference calls, 1:1 report introduction calls, as well as support and presentations at regional and annual program meetings.
- Develop and manage communication of results and performance of assigned captive programs to internal and external parties, including analysis of historical performance and interpretation of loss performance.
- Develop and manage surveys and voting for assigned captive programs.
- Work with distribution channel and captive members in development and implementation of risk management strategies and education of potential health risk management solutions/vendors.
- Support the launch of new captive programs including establishing the cession reporting, coordinating calls and logistics with Program Sponsor/Captive Manager to ensure a smooth implementation.
- Development of documentation/recommendation of processes and procedures to support efficiency and growth targets for the captive division.
- Effectively liaison with various operating areas including premium accounting, finance, and clinical team on behalf of policyholders and consultant brokers to ensure understanding of claims handling, premium processes, policy provisions/endorsements and understanding internal health risk management services.
- Work with vendor relationships to maintain smooth coordination between the parties (TPAs, disease management, broker, captive, members, etc.).
- In collaboration with AVP, oversee the activities of account management team assigned to programs, including training, development, and input on performance review to ensure appropriate coordination of information and resources to achieve customer service standards. At times providing back-up and support in interfacing with broker, policyholder and TPAs.
- Projects, as assigned.
This role is responsible for delivering successful project outcomes through the use of thought leadership, peer influence, and project management best practices. This role concurrently manages a rolling portfolio of approximately five, multi-month efforts relating to application (re)configuration, data reporting, and business process improvement. Projects are staffed using a matrixed-structure using cross-functional resources that do not have direct reporting authority to the Project Manager. At times, the role augments team resources by performing business analysis tasks when pertaining to a technical nature.
Your responsibilities in this role are to:
- Oversee and manage IT related projects with the goal of delivering an effective solution in a timely manner
- Proactively engage business users by organizing and leading project team meeting
- Lead the collection, documentation, and understanding of all business requirements
- Successfully work through with the IT department the conversion of business requirements into IT specifications
- Document and communicate deliverable challenges and proactively identify solutions to those challenges
- Resolve differences of opinion amongst business user where and when they exist
- Develops and maintains project plans, work estimates, risk registers, contact lists, status reports, etc.
- Actively manages scope, timelines, and resources to successfully deliver projects
- Provides regular status, communication, and management follow ups through self-directed time management
The Senior Underwriter will seek profitable growth of the company’s portfolio of stop loss business by analyzing and selecting risks based on qualified underwriting criteria that adhere to the company’s established underwriting guidelines. This position will work cross-functionally with clinical, actuarial, claims and distribution to carry through new and renewal business strategies in a professional and thoughtful manner. This role is an individual contributor role, working under the supervision of the Underwriting Manager and/or AVP, Underwriting. In this capacity, the Senior Underwriter will manage his/her workload with a sense of urgency around quote deadlines and production targets. This role will require proactive collaboration with underwriting management to review more complex cases requiring a higher degree of underwriting authority. Duties and responsibilities include but are not limited to:
- Write and retain profitable stop loss cases adhering to the company’s guidelines and within assigned letter of authority.
- Work collaboratively with clinical underwriting staff to ensure adequate risk premium is established based on known, ongoing claimants.
- Develop and maintain successful relationships with target production sources within assigned programs, as well as with BAH Sales and Account Management.
- Accurately document underwriting thought process and authority reviews through company journal and filing system.