Excellus BlueCross BlueShield Rating Analytics Specialist in Rochester, New York
Rating Analytics Specialist
Rochester, Syracuse, Utica
The Rating Analytics Specialist’s primary responsibilities involve assisting management in meeting corporate goals and strategic decision making through data driven work activities. The role is accountable for ensuring the appropriate application of departmental
policies and procedures and serves as an advisor to rating staff in support of the rate development process. This position interacts regularly with many internal parties and management regarding rating and underwriting business practices, processes, and projects.
• Compiles and analyzes data while performing complex modeling to draw conclusions and make recommendations in support of key initiatives for Rating & Underwriting, Sales, Marketing, Actuarial, and other Departments.
• Propose and assists in the development of process improvements and automation utilizing system and software applications to full potential.
• Creates and maintains Experience Rated Monitoring and Book-of-Business Tracking reports.
• Produces and analyzes production and efficiency metrics to assist in workflow management efforts.
• Prepares settlement estimates for alternately funded groups; interacts with accounting to respond to questions and ensure timely and accurate reporting.
• Produces competitive benchmarking through the evaluation of competitor rate development, underwriting guidelines, benefit plans, rates, reporting packages, and provider reimbursement.
• Acts as an advisor to other rating staff.
• Participate in the establishment of health cost and utilization trends as well as other renewal and new business quote factors in conjunction with Pricing.
• Represents Rating in cross-functional meetings.
• Monitor processes and procedures to ensure consistency and quality; Ensures peer review and documentation requirements are met.
• Assist with policy recommendations.
• Assist with departmental goal setting and execution.
• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values and adhering to the Corporate Code of Conduct.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
• Maintains knowledge of all relevant legislative and regulatory mandates and ensures that all activities are in compliance with these requirements.
• Regular reliable attendance is required.
• Performs other functions as assigned by management.
• BS in Math, Economics, Actuarial Science or allied field.
• Five years of experience in underwriting or related field in the health care industry with proven ability to effectively manage large complex projects.
• Must have thorough knowledge of rate proposals, renewals, stop loss quotes and settlements.
• Good operational background with a strong ability to prioritize, plan and problem solve in a team environment
• Extensive knowledge of local markets
• Knowledge of financial and risk health arrangements with extensive knowledge of state and federal laws and regulations relating to health insurance
• Assist in the enforcement of Underwriting guidelines
• Extensive background using Milliman USA Health Cost guidelines for rating and benefit adjustments
• PC skills required:
o Expert level in Microsoft Excel
o Intermediate level in Microsoft Word
o Beginner level in Microsoft Powerpoint
o Intermediate level in Microsoft Access
o Intermediate level in Impromptu or other data extraction tool
• Strong interpersonal skills to ensure effective interactions with staff, other internal departments and external contacts
• Excellent verbal and written communication skills
• Continued professional growth in Rating and Underwriting or Actuarial field as evidenced by successful completion of course work and exams
• Intermediate knowledge of NYS Underwriting regulations preferred
• Designations include CHC, FAHM, RHU and CEBS
• Graduate level is a plus
• PC skills desired:
o Beginner level in Powerplay
o Lotus Notes
o Mainframe skills preferred
o SAS and/or VBA experience desired
o Experience using StepWise strongly preferred
Other Essential Characteristics
• Ability to perform under pressure
• Ability to adapt to rapidly changing priorities
• Good analytical skills with a focus on meeting expectations and requirements of both internal partners and external customers.
• Demonstrated analytic abilities combined with capabilities for completing projects with minimal degree of supervision.
In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.
Equal Opportunity Employer
We are an Equal Opportunity Employer.
Please view Equal Employment Opportunity Posters provided by OFCCP
- We are an Equal Opportunity Employer, and as such affirm the right of every person to participate in all aspects of employment without regard to race, color, sex/gender, age, disability, religion, creed, citizenship status, national origin, veteran status,
military status, marital status, familial status, domestic violence victim status, sexual orientation, gender identity, predisposing genetic characteristic, genetic information, or any other status protected under the law.
- The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access
to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure
is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information.