Manager Underwriting Compliance

Position Description

At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.” 

Determine decisions in coordination with Director of Actuarial Operations on rate calls for commercial group medical underwriting for prospects. Makes business decisions on requests for exceptions to UW Compliance guidelines and eligibility for coverage in the NonLarge commercial market. Makes business decisions for and manages auditing of Individual Account SEP and Medicare Supplemental SEP applications in regard to compliance with both internal policies and CMS regulations related to eligibility to enroll. Collaborates with the Director of Actuarial Operations to leverage resources to ensure SLAs for underwriting audits are met. Evaluates process flows for efficiency and opportunity for automation as well as need to change due to corporate or UW business needs, market trends or regulatory requirements. Maintains UW Compliance Guidelines and ensures staff is trained and performs audits accordingly. Assures high performance levels are met through activities including recruitment and development of staff through education, mentoring and coaching. Serves on corporate committees and work groups, as necessary, to provide input for corporate initiatives.

Responsibilities and Qualifications

• Determine decisions on requests for exceptions to UW Compliance guidelines by evaluating risk, past business practices, and impact to customers and/or the market. Make business decisions on medical underwriting rate calls for Non Large commercial group prospects.
• Responsible for oversight of flow of commercial Small Group and Mid-Market group Sales paperwork through the UW Compliance unit.
• Represent UW/Actuarial departments on various corporate committees and project teams as appropriate
• Evaluate Process flows to react to changes in business needs and to implement process improvements
• Manage People; Recruit and Develop staff
• Supervise the quality of performance of UW Compliance staff performing group audits and related activities - motivate to meet or exceed goals while maintaining adherence to relevant policies
• Makes business decisions for and manages auditing of Individual Account SEP and Medicare Supplemental SEP applications in regard to compliance with eligibility to enroll.
• Assist in revising UW Compliance Guidelines and external letter templates related to group audit processes and outcomes
• As necessary, provide back up for various tasks normally performed by lead Compliance Specialist or Compliance QC Underwriter.
• Create monthly reports and ad-hoc reports as necessary

Skills:

• Requires demonstration of leadership skills including motivating, scheduling and enhancing collaboration across cross-functional teams and/or focused work groups.
• Understanding of CBC corporate structure including knowledge of standards and policies, business practices and procedures.
• Persuasion and negotiation skills to resolve differences with skill and understanding.
• Ability to act as a liaison and recommend solutions to a variety of departments as well as external entities.
• Ability to perform duties with minimal supervision.

Experience:

• Must possess effective verbal and written communication skills.
• Must possess strong quantitative analysis skills to evaluate rate change requests.
• Must be proficient with MS Word, Excel, internet searching and web based tools.
• Experience in Salesforce, MARIS and Stepwise a definite plus.
• Minimum 5 years’ experience related to the principles of risk selection.
• Minimum one year experience as a project/team lead.

Education and Certifications:

• Requires a bachelor’s degree or equivalent work experience in health insurance or health care industry.
• Maintain a professional level of competence through continued education and exposure to technologies/methodologies.

Other:

• Key Interfaces:
• Sales, Producer Relations, Producer Support, Sales Services, E&B, other Underwriting and Actuarial management, Group Policy Makers

 

About Us

We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a diverse and caring team of supportive colleagues, and be encouraged to volunteer in your community.  We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career.       And by doing your best, you’ll help us live our mission of improving the health and well-being of our members and the communities in which they live.