POSITION SUMMARY
Under general direction, establishes premium rates for existing and new employer groups, and/or individuals, to achieve company revenue, margin, and membership targets. Works strategically with the Sales Department on proposals to offer competitive pricing and alternatives that align to employer goals and conditions of offering. Identifies and analyzes internal and external factors that may affect HDS’s revenue, margin, and membership including the review of historical data and economic forecasts to predict underwriting profitability at the group, business line, funding arrangement, and overall levels. Assists in the preparation of the annual underwriting forecast and reports on revenue, margin, membership, and utilization trends and projections for management to consider in decision making. Provides analytical support for company initiatives, reporting, and research.
ESSENTIAL DUTIES AND RESPONSIBILITIES
- Produces accurate and timely employer group rate proposals and supporting reports that adhere to existing underwriting policies and guidelines. Partners with Sales to provide appropriate information that will increase the likelihood of success in renewing existing groups and acquiring new groups. As needed, supports Sales on customer and broker/consultant meetings, calls, and other communication. Conducts peer review on rate proposals, reports, and other department and company-wide analyses. Calculates and recommends rates for individual plans. Assists with regulatory filings.
- Assists with compiling the annual underwriting forecast. Gathers input from Sales and other departments to formulate forecast assumptions. Monitors trends in utilization, margin, and enrollment at the company-wide, line of business, and other aggregate levels, and notifies management of anything unusual. Reviews and analyzes actual-to-budget data and discusses significant variances with department management and other leadership. Reviews economic trends and forecasts, and competitive data, and evaluates their potential impact on company revenue, utilization, margin and/or membership. Provides input, helps to maintain, and suggests changes to the forecast model.
- Supports overall plan benefit strategies, pricing strategies, and other initiatives of the organization. Assists in the analysis of existing benefits and limitations, new products, and markets in order to propose recommendations to better manage utilization and grow business. Determines impact of these recommendations to individual groups and collections of groups. Conducts ad hoc analyses to support company research, reporting, and initiatives. Develops reports for other departments to provide them with the ability to improve analysis, operational efficiencies, and reporting capabilities.
- Calculates or supports the calculation of group-specific and book of business incurred but not received (IBNR) claims analysis. Compares results with other established industry methods and makes recommendations to improve the estimated IBNR calculations. Provides analytical support of proposed provider fee schedule changes and claims processing guideline changes and works with other departments to implement approved changes.
- Analyzes effectiveness of work processes and proposes recommendations for continuous improvement and consistency across the team. Assesses current and researches and evaluates new rating and underwriting methodologies. Determines impact of changes across the company's finances and operations and makes recommendations for improvement. Identifies and makes recommendations to pricing, underwriting, and reporting models. Implements changes as needed.
- Other Duties and Responsibilities
- Assists with the design, writing, maintenance, and production of departmental manuals including but not limited to standard operating procedures and guidelines, process flow charts, and user manuals.
- Assists department management with special projects.
- Other miscellaneous duties and responsibilities as assigned.
MINIMUM QUALIFICATIONS AND EXPERIENCE
Education
Bachelor’s degree in mathematics, actuarial science, data analytics, economics, statistics, finance, business administration or equivalent in education, experience, or training.
Experience
- Three (3) years of progressive experience in rating, underwriting, actuarial or related field with background in group rating processes for health or dental insurance, or the equivalent in an analytical role that included conducting detailed analysis using databases.
- Strong knowledge of Microsoft Excel and Word.
- Working knowledge of SQL, Tableau, and statistical analysis preferred.
Skills and Knowledge
- Working knowledge of Microsoft Word and Excel. Preferred experience in writing queries using Oracle SQL or other programming language and Tableau. Preferred knowledge in the use of Microsoft PowerPoint.
- Ability to organize, analyze and solve complex problems.
- Ability to handle and prioritize multiple tasks with some distractions.
- Ability to focus on details.
- Ability to effectively communicate both orally and in writing with all levels of staff, customers, consultants/brokers, and vendors on sensitive matters.
- Technical knowledge to learn and understand computer applications for problem-solving and answering questions (prefer Windows, Word, Excel, and PowerPoint).
Note: The above information in this description has been designed to indicate the general nature and level of work performed by an employee in this classification. It is not to be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications of employees assigned to this job. Hawaii Dental Service has the right to add to, revise, or delete information in this description. Reasonable accommodation will be made to enable qualified individuals with disabilities to perform the essential functions of this position.