Supervisor Underwriting

For more than 70 years, Blue Cross and Blue Shield of Kansas has built a reputation of trust. As we move forward in this new era of health care we want to continue that tradition. Whether a member needs Blue Cross to cover an annual check-up or give them peace of mind during a major medical crisis, we want our members to know they can trust BCBSKS to meet their needs. Our mission: Being the insurer Kansans trust with their health. ***Equal Opportunity Employer/Veterans/Disabled*** ***Blue Cross Blue Shield of Kansas invites any applicant and/or employee to review the Company’s written Affirmative Action Plan. This plan is available for inspection upon request by contacting the EEO Office at (785)291-8639.*** Under the direction of the Manager of Underwriting, this position supervises all aspects of compliance of underwriting eligibility and enrollment guidelines for group and individual business. In addition, this position has oversight of staff responsible for disposition of medically underwritten applications by evaluating health risk to control financial loss to the Plan. Through established underwritten processes, and in partnership with Sales, Rating and Actuarial, responsible for acquisition and retention of large and small group business, Medicare Supplemental, ancillary products, and existing individual add-ons. Individual must have strong communication and negotiation skills in working with both prospective and renewal customers and groups, explaining to them our underwriting eligibility and participation methodologies. Position will represent Underwriting in divisional and cross-divisional team settings as well as plans, coordinates, and organizes the workload throughout the unit to provide the most efficient and accurate results. This position is eligible to work a hybrid schedule (combination of remote and onsite) in accordance with our Telecommuting Policy. Position located in the Topeka office. Applicants must reside in Kansas or be willing to relocate as a condition of employment.” Are you ready to make a difference? Choose to work for one of the most trusted companies in Kansas. Essential Functions Lead the daily operations of the Enrollment Risk area. Responsible for ensuring groups meet eligibility and participation requirements based on established underwriting guidelines. Review and determine if all pertinent information have been provided in developing risk and/or eligibility evaluation. Request missing information from appropriate resources and ensure timely follow up to meet departmental goals and deadlines dictated by Market demand. Clarifies prospective large group accounts for rating purposes by evaluating health risk components. Before rates can be calculated the Underwriting Analyst must conduct an extensive review of all components of the underwriting process, i.e., applicant, health conditions, eligibility, BCBSKS claims history and enrollment, completeness of forms submitted, and research of previous underwriting decisions made. Oversee the testing and development of system enhancements, upgrades and projects related to assigned duties. Responsible for developing and maintaining professional partnerships with BCBSKS Sales personnel, individual applicants/insureds, group leaders, providers, and provider office personnel. Responsible for both verbal and written communication with external customers to obtain information regarding health conditions and eligibility to make a complete and accurate decision. Includes contacts with applicants, group leaders, providers, and provider office personnel. Responsible for both verbal and written communication with internal and external customers either to provide directive, guidance and/or obtain information. Includes contacts with personnel in various departments, i.e., Sales, Legal, Special Investigations, Membership, Claims, Customer Service, Actuarial Research, etc. Ensure underwriting regulations, as well as group and member contracts are being enforced through ongoing education provided to internal departments (CSC, Membership and Sales) and external customers. Must maintain knowledge of current Federal and State regulations and statutes, as they pertain to our corporate business. Must safeguard protected health information as required by HIPAA Privacy regulations. Ninety percent of time is spent on a PC, researching and evaluating online/hard copy reference material (i.e., internet sites, prescription drug manuals, medical dictionaries, online manuals, etc.), claims reports and previous prospect/enrollment files, and a minimum of ten percent of time on the telephone. Responsible for oversight of dispositions of re-review for Medicare Supplemental applicants (i.e., why denied coverage). Must be available for work when scheduled. Successful candidate will be required to maintain a low record of absences. Qualifications Education High school graduate or equivalency required. LPN, Certified Nurses Aid or Certified Medical Aid and/or experience coding medical records using ICD 9 or 10 methodologies preferred. Experience Minimum of 5 years underwriting experience, to include experience specific to enrollment and eligibility within the health insurance industry. Skills Knowledge of medical terminology. Medical terminology course is preferred. Incumbent must complete in-house Medical Terminology course within six months of hire date. Preferred two years working knowledge of current BCBSKS membership and claims systems. Must be proficient in Office applications such as Word, Excel, Teams and Outlook. Ability to research, evaluate and decide the disposition/eligibility of prospective applicants and enrolled members while exercising problem solving skills, good judgement, and attention to detail and accuracy. Knowledge of medical underwriting procedures, and an overall knowledge of plan products and functions of other departments, preferred. Strong written and oral communication skills, with the ability to interact professionally with both internal and external customers. Must possess superior skills in organizing and prioritizing work independently to meet individual goals, as well as department goals, daily. Must support and work actively in a teaming environment. This includes assisting others with workloads to ensure department goals are met. Demonstrated ability to understand department and enterprise policies and procedures as required Compensation BCBSKS Grade Exempt 17 Minimum salary starting at $90,640 Salary determined based on education, skills and experience Posting Close Date December 7, 2022 Pay Rate Type Salary