"Alerted.org

Excited to grow your career?We value our talented employees, and strive to help employees grow professionally. If you think the open position you see is right for you, we encourage you to apply!

Job Description:

Summary:

The Stop Loss Analyst develops new business rate proposals utilizing available claim information provided from prospect accounts through Sales. The Stop Loss Analyst also develops renewal rates for existing group accounts utilizing claim, premium and enrollment information extracted from Excellus Health Plan, Inc.’s systems. This position prepares stop loss quotes and group reports to assist Sales in the acquisition and retention of accounts; interacts with company sales representatives, account personnel, and consultants regarding rate, trend explanations, and rate negotiations. The Stop Loss Analyst interacts with other internal departments such as Rating, Treasury, Accounting, Actuarial, Network Management, Provider Contracting as necessary.

Essential Primary Responsibilities/Accountabilities:

Level I:

+ Performs extensive analysis necessary for developing competitive bid rates on new business opportunities, as well as renewing existing accounts.

+ Evaluates stop loss plan variables and suggest appropriate levels of coverage.

+ Partners with Sales in working directly with customer accounts, their brokers and consultants, in support of rate negotiations on new or renewal business.

+ Partners with Sales in meeting persistency goals related to existing stop loss business.

+ Prepares specific and aggregate stop loss reimbursements for all groups that have purchased Excellus Health Plan. Inc. stop loss.

+ Prepares necessary reports for specific and aggregate claim submissions for all groups that have purchased stop loss through an external vendor.

+ Works with other internal areas to ensure proper billing and collection of stop loss premiums.

+ Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values and adhering to the Corporate Code of Conduct and leading to the Lifetime Way values and beliefs.

+ Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.

+ Regular and reliable attendance is expected and required.

+ Performs other functions as assigned by management.

Level II: In addition to Level I responsibilities:

+ Completes new business and renewal quotes for more complex groups (e.g. external drug, non-Excellus TPA).

+ Peer reviews new business and renewal quotes for other Stop Loss Analysts.

+ Creates and maintains Stop Loss Monitoring and Book-of-Business tracking reports to meet profitability goals.

+ Develops ad hoc reports as a supplement to the group rating process through query building and data extraction.

+ Proposes and/or assists in the development of process improvements utilizing system and software applications to full potential.

+ Participates in cross training of Stop Loss staff, Sales staff and other areas, as necessary.

Level III: In addition to Level II responsibilities:

+ Serves as a mentor and resource to Stop Loss Analysts.

+ Interacts with internal and external sales representatives, accounts and consultants regarding rate and trend explanations and rate negotiations.

+ Responds to Requests for Proposal (RFP) questions and actively participate as part of the RFP response team.

+ Proposes and/or assists in development of process improvements and automation of processes within the Stop Loss Team.

+ Assists in ad hoc projects in support of the Sales, Marketing, and Actuarial initiatives.

+ Evaluates and analyzes competitor rates/benefit plans for the development of trends and other renewal factors to be used in the Stop Loss rating model.

Level IV: In addition to Level III responsibilities:

+ Responds to complex Requests for Proposal (RFP) questions and actively participate as part of the RFP response team, including bidder conferences.

+ Evaluates and analyzes competitor contracts to recognize: emerging shifts in the marketplace; strategies to preserve business; methods to reduce risk for the company; and new product features for customers.

+ Represents R&UW team in place of Stop Loss management on high level, cross-functional work teams, such as CBB Steering Committee.

+ Interacts with external customers regarding all Stop Loss functions.

Minimum Qualifications:

NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities

Level I:

+ BS in Math, Economics, Accounting, Actuarial Science or related field. In lieu of a Bachelor’s degree, an Associate’s degree with two years of related experience or No degree and four years of related experience may be considered.

+ Operational background with a strong ability to prioritize, plan and problem solve in a team environment.

+ Good analytical skills with a focus on meeting expectations and requirements of both internal partners and external customers.

+ Knowledge of State and Federal Laws and Regulations relating to health insurance.

+ Excellent verbal and written communication skills.

+ Ability to perform under pressure and adapt to rapidly changing priorities.

+ PC skills required.

Level II: in addition to Level I qualifications:

+ A minimum of three years of additional experience in a stop loss, rating, underwriting or related setting.

+ Knowledge of the Milliman, Inc. Health Cost Guidelines for Reinsurance.

+ Knowledge of State and Federal Laws and Regulations relating to stop loss insurance.

+ Knowledge of other financial and risk arrangements.

+ Knowledge of diagnosis and procedure codes.

+ Ability to access the company’s care management platform (e.g. Clinical Care Advance).

+ Ability to access the company’s claim and enrollment system (e.g. Facets) in order to look up claim information and verify eligibility and rates.

+ Intermediate level in Excel, Word, and other Microsoft products.

+ Intermediate level in data extraction tools such as Cognos or SAS.

Level III: in addition to Level II qualifications:

+ A minimum of five years of additional experience in a stop loss, rating, underwriting or related setting.

+ Ability to perform complex rate quoting independently.

+ Continued professional growth as evident by successful completion of, or willingness to complete, course work and exams for HIAA or other learning opportunities.

+ Understands health insurance & health insurance products, managed care, accounting principles, competitive market, legislative environment, and any regulatory issues affecting the Health Plan.

+ Proficient in Excel, Word, and other Microsoft products.

+ Proficient in data extraction tools such as Cognos or SAS.

Level IV: in addition to Level III qualifications:

+ A minimum of seven years of additional experience in a stop loss, rating, underwriting or related setting.

+ Experience must include knowledge of multiple lines of business, funding arrangements, and stop loss specific tasks.

+ Strong understanding of other functions such as Rating, Underwriting, Actuarial, Accounting, Provider Contracting, Network Management, Product Development, Medical Management, etc., and how they impact Health Plan operations and financials.

+ Knowledge using the Milliman, Inc. Health Cost Guidelines for Commercial Rating Structures and associated Managed Care Rating Model.

+ Ability to interact and defend rate assignment process at the group and/or broker level.

Physical Requirements:

+ Ability to travel across regions.

********

In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.

Equal Opportunity Employer

Compensation Range(s):

Level I: Grade E1: Minimum $60,410 - Maximum $84,000

Level II: Grade E2: Minimum $60,410 - Maximum $96,081

Level III: Grade E3: Minimum $60,410 - Maximum $106,929

Level IV: Grade E5: Minimum $71,880 - Maximum $129,384

The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position’s minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays.

With about 4,000 employees, 31 counties, and serving the needs of over 1.5 million members, you can imagine the gamut of skills it takes to keep our organization growing and our members flourishing. As an internal job seeker, this means growth and development in many directions, divisions, and roles.Take a look at information regarding our hiring process here. https://lifethc.sharepoint.com/sites/HumanCapitalManagement/SitePages/Talent-Acquisition-%26-Onboarding.aspx#hiring-process All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.