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Medical Underwriter

Company: SET SEG
Location: East Lansing
Posted on: March 16, 2020

Job Description:

SET SEG is looking for a detail-oriented Medical Underwriter to provide extensive industry expertise and analytical support to SET SEG's sales and consultative work with Michigan public schools. The Medical Underwriter will evaluate and optimize health plan expenses, secure coverage from commercial insurers and stop-loss carriers, analyze plan performance, support face-to-face client and prospect meetings, and help design innovative risk management programs unique to SET SEG. This position will also guide and oversee the design of reports and tools to convey complex information in a simplified, consistent, and repeatable format that provides practical insights and recommendations. The Medical Underwriter will work with single employer cases and state-wide analysis of trends. This position reports to the Chief Program Administrator.
WHO WE ARE School Employers Trust (SET) is a non-profit company that was created after a monumental shift in school funding happened in 1965. SET, which began in 1971, served as an employee benefits association focused on offering comprehensive and affordable employee benefit solutions to Michigan public schools and their employees. Two years later, its partner organization School Employers Group (SEG) was formed to administer compensation and fringe benefits for SET. As schools were faced with more challenges related to insurance, SEG evolved and grew into a company that provides workers' compensation and property/casualty services for Michigan public schools.
Today, SET SEG continues to expand and find creative ways to meet the specialized needs of its members. This, coupled with a superior member experience, is why SET SEG has maintained its position as an industry leader in the school insurance market.
We value those who proactively solve challenges, simplify the complex, thrive in a fast-paced setting, have a customer-first mentality, and seek a collaborative and inclusive work environment. We are also listed on the Business Insurance Best Places to Work. We offer 100% employer paid insurance (medical, dental, and vision), Paid Time off (PTO), and paid parental leave.
Our passion is delivering peace of mind to Michigan public schools and we look for team members who are motivated by our cause. To learn more, visit: . WHO YOU ARE
You are energized by working with a collaborative team and industry peers to support Michigan public schools through their challenges. You seek understanding and are motivated to tackle projects and problems with the customer in mind. You anticipate needs and preempt challenges and concerns, delivering increasingly relevant customer experiences over time. You value a culture that is rooted in mutual respect, where you can learn from different perspectives and roles.
You are an experienced and detailed individual with over ten years of medical underwriting experience with at least one carrier, TPA, or consulting firm. You have an in-depth understanding and ability to use Microsoft Excel-- and other specialized data analysis tools. You have strong technical skills to enable efficient analysis and have a demonstrated knowledge of self-funding benefit plans. You are able to work with a sense of urgency without losing any precision. You have strong interpersonal and communication skills, allowing you to address various audiences internally and externally. You have the ability to understand and adapt to Michigan public school culture to best serve our customers. You know how to prioritize deadlines and have excellent customer service. You are a team player and a dedicated employee.
--- Primary Responsibilities:

  • Evaluate, quantify, and communicate healthcare plan risk and performance data.
  • Perform claim performance funding analyses and modeling.
  • Analyze releases of data under Michigan Public Acts 106 of 2007 and 579 of 2018.
  • Design ad hoc and systematized reports to convey health plan information to internal and external customers.
  • Develop illustrative rates for self-insured programs, carveouts and employer funding of clinics/HSAs/HRAs.
  • Analyze differences in excess contracts terms and conditions and specific decease/condition carve out coverages.
  • Consult on medical plan design options, network participation and alternative claim pricing models.
  • Monitor compliance with carrier reporting requirements include in insurance contracts.
  • Assist with carrier rate negotiation.
  • Perform IBNR and claim lag analyses.
  • Analyze plan renewals and rate exhibits.
  • Analyze school compliance with the "Publicly Funded Health Contribution Act", PA 152 of 2011.
  • Develop risk management programs, including using risk pools, captives, and third parties.
  • Support external sales and consulting staff by providing analysis and reports to be shared with schools.
  • Compose school-friendly executive summaries and commentary on specific and general medical claim findings.
  • Use third-party tools to augment health plan performance analysis and communication.
    Required Qualifications:
    • Bachelor's degree in math or science-related field or equivalent
    • Ten years of medical underwriting experience with at least one carrier, TPA, or consulting firm
    • Demonstrated knowledge of self-funding benefit plans
    • In-depth understanding and ability with Microsoft Excel-- and other specialized data analysis tools
    • Strong technical skills to enable efficient analysis
    • Ability to execute work with an effective balance between urgency and precision
    • Strong interpersonal and communication skills to address various audiences internally and externally
    • Ability to understand and adapt to Michigan public school culture
    • Ability to prioritize deadlines, customer service, and quality measures in dynamic environment Physical Demands / Work Environment
      Several hours per day at a sit/stand desk, average mobility to move around an office environment; able to spend several hours per day at a computer; travel to various locations throughout Michigan. Punctual, regular, and consistent attendance is required. May require on-call availability and may require working during non-business hours and on weekends.
      We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace.

Keywords: SET SEG, East Lansing , Medical Underwriter, Healthcare , East Lansing, Michigan

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