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   Current UPMC employees must apply in HR Direct

Underwriter III - Health Plan

Description

UPMC is the largest medical and behavioral health insurer in western Pennsylvania, insuring more than 3.5 million lives. UPMC Insurance Services Division serves as the centralized hub for a wide array of health insurance plan services and operates in the Downtown Pittsburgh campus located at the US Steel Tower.

 

UPMC Health Plan is dedicated to improving the health and well-being of our members as well as the greater community. UPMC Health Plan currently has an exciting opportunity for a full-time Underwriter III role. This will be a Monday through Friday (8:00 a.m. – 4:30 p.m. / 8:30 p.m. – 5:00 p.m.) daylight position and will be based out of downtown Pittsburgh. Due to COVID-19 circumstances, this will be a remote role temporarily.

 

The Underwriter III will perform the most complex rating projects and act as a mentor/trainer to the rest of the department as it pertains to risk assessment, including the determination of both the financial and non-financial impact to the Health Plan. An Underwriter III works in conjunction with the Manager of Underwriting and Actuarial Services to develop a series of rating models, Underwriter Guidelines and Rate Request/Prospect Information Forms. It is the duty of an Underwriter III to stay abreast of regulatory changes and their impact on the underwriting process.



Responsibilities:
  • Underwriting items such as IBNR, accounting for plan/premium changes, appropriate use of credibility, medical underwriting are to be handled with great proficiency.
  • Utilize and apply the underwriting guidelines appropriately and the ability to perform additional risk analysis.
  • Act as a consultant to the marketing department.
  • Proficiency in rating groups based on claims experience, requiring minimal assistance/guidance. Upon review of this work by more senior underwriters and management, less than 3% of work requires material correction.
  • The ability to think outside the box when rating groups and using the rating tools to accommodate quality of data, applicability of the Health Plan tools' factors relative to the carrier/product being rated, and the health plan's rates relative to the competition.
  • Deliver and explain renewal rating actions to enforce clients and initial rating actions to potential clients and their consultants.
  • Develop and maintain training documents and processes for the staff relative to experience rating and the explanation of the developed rates to internal and external parties.
  • Analyze and consolidate competitor information on an ongoing basis and report findings to management. Work with management in the development of underwriting policy, procedure and rating tools.

Qualifications

  • Bachelor's Degree with a major in Mathematics, Finance or Business Administration or 2 years of group underwriting experience required. 
  • 5 to 10 years of experience in group underwriting with extensive exposure with rating, based on claims experience required. 
  • Computer skills including knowledge of excel and demonstrate competency in mathematics, attention to detail, and the ability to work in teams is required.

Licensure, Certifications, and Clearances:


UPMC is an Equal Opportunity Employer/Disability/Veteran

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   Current UPMC employees must apply in HR Direct

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