Get To Know Us!
Come and grow your career with the Commercial Insurance Market! We maintain profitable growth delivered through competitively priced, locally tailored medical health solutions that provide a clearly superior value to our group and individual customers. We offer competitive salaries and benefits, work-life balance, flexible work arrangements, opportunities for growth and development, and a great place to work across our enterprise!
What Will Be Your Purpose
Small Group Underwriting Specialists are responsible for:
- Determining acceptance of group applications by reviewing and analyzing prior medical history, current health history, claims history and anticipated future medical costs.
- Auditing the functionality of the Small Group Balance Funding automation processes
- Performing analysis on the group’s performance and identifying opportunities to adjust underwriting guidelines and processes to improve financial results.
What Will You Be Doing
- The functions listed represent the major duties of this role, additional duties may be assigned.
Financial Job Functions
- Assess underwritten Small Group Balance Funding applications.
- Risk assessment – apply medical underwriting guidelines to achieve the best risk in this market segment.
- Review group medical questionnaires and determine appropriate calculation of debit points.
- Review claims data on groups currently or previously enrolled with Florida Blue
- Analyze medical documentation in risk evaluation.
- Research and resolve Sales inquiries.
- Analyze data to evaluate group renewal.
- Evaluate credit/refund settlements based on difference between aggregate and actual claims paid.
- Prepare Annual Accountings when necessary.
- Identify the need for new/revised underwriting policies and procedures based on trends, changing practices as well as new development of State and Federal regulations.
- Analyze monthly reporting for this market segment
Relationship Job Functions
- Develop working relationships across departments to include but not limited to Sales, Actuarial, Membership and Billing and Enrollment as needed.
- Lead Instructional Meetings and Internal Presentations and/or training sessions as needed.
- Contribute to the development of Standard Operating Procedures, job aids and training documents as needed.
Project and Workgroups
- Participates in formal and informal projects.
- Supports monthly reporting.
- Provide workgroup support at the corporate level as needed.
What You Must Have
- 4+ years related work experience.
- 2 or more years related underwriting work experience.
- Understanding of medical underwriting philosophy, fundamentals, and principles
- Knowledge of commonly encountered medical conditions, basic understanding of contracts.
- Knowledge of medical and legal terminology associated with the underwriting process.
- Demonstrated knowledge and understanding of various Florida Blue business systems that support the underwriting process.
- Claim analysis experience.
- Working experience with group health insurance products, pricing, financing, underwriting, and marketing strategies
- Additional relevant medical/insurance experience may be substituted for a degree.
- Knowledge of state and federal statutes and regulations.
- Understanding of underwriting philosophy, fundamentals, and principles
Excellent understanding of contracts - Thorough knowledge of the Company’s systems and ability to modify or develop new procedures to meet specialized needs.
- Ability to interpret and analyze medical and other underwriting data.
- Process and technical proficiency of various underwriting systems that support the group underwriting and renewal processes.
- These systems include but are not limited to: Siebel, E-rate, Renewal Rating Tool, MBI, Milliman GRx, Alternate Tool, Demographic Tool and RBMS.
- Experience in the Microsoft Office Suite (i.e., Excel, Word, Power Point) and SharePoint
- Ability to quickly learn new or enhanced system functionalities and capabilities and business process flows.
- Strong multi-tasking skills self-motivated and directed.
- Must be responsive, detail-oriented and able to meet established quality audit deadlines.
- Ability to systematically review and consider alternatives in order to make good judgments.
- Must enjoy a fast-paced team environment, with the ability to work under time pressure.
- Ability to persuade and negotiate and exhibit strong business acumen
What We Prefer
- Bachelor’s degree
- RN or related bachelor’s degree
- HIA and MHP designation Math, Insurance, Risk Management or Business
- Master’s degree in a related field Math, Insurance, Risk Management or Business
- RN – Registered Nurse – State Licensure And/or Compact State Licensure
General Physical Demands
- Exerting up to ten pounds of force occasionally to move objects.
- Jobs are sedentary if traversing activities are required only occasionally.
What We Offer
As a Florida Blue employee, you will thrive in our Be Well, Work Well, GuideWell culture where being well as an individual, and working well as a team, are both important in serving our members and communities. To support your wellbeing, comprehensive benefits are offered. As an employee, you will have access to:
- Medical, dental, vision, life, and global travel health insurance.
- Income protection benefits: life insurance, Short- and long-term disability programs.
- Leave programs to support personal circumstances.
- Retirement Savings Plan includes employer contribution and employer match.
- Paid time off, volunteer time off, and 11 holidays.
- Additional voluntary benefits available; and
- A comprehensive wellness program.
Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for intern, part-time and seasonal employees may differ.
Salary
To support your financial wellbeing, we offer competitive pay as well as opportunities for incentive or commission compensation. We also conduct regular annual reviews with pay for performance considerations for base pay increases.
- Annualized Salary Range: $64,800 – $105,300
- Typical Annualized Hiring Range: $64,800 – $81,000
- Final pay will be determined with consideration of market competitiveness, internal equity, and the job-related knowledge, skills, training, and experience you bring.
We are an Equal Opportunity/Protected Veteran/Disabled Employer committed to creating a diverse, inclusive, and equitable culture for our employees and communities