Excess Loss Analyst I

Arkansas Blue Cross and Blue Shield - Little Rock, AR (30+ days ago)4.1


The excess loss division of ABCBS is responsible for facilitating “excess loss” contracts for self- funded customers. The excess loss division assists the customer in execution of these contracts, and fulfills an administrative role in reporting, filing specific and aggregate excess loss claims, and payment of the large claims. The Excess Loss Analyst I will assist Excess Loss Analyst II and III as well as the Supervisor of Excess Loss in soliciting quotes, interpreting the results, and communicating those results to the marketing staff, manages concerns related to quote activity and play a role in the resolution of all issues between the customer and the carrier. Accordingly, the Analyst is required to have excellent communication skills. The analyst should have some knowledge of the health insurance industry. Finally, the Analyst must be able to evaluate various alternative factors related to the price and conditions of the contract, and be able to communicate these to groups and sales representatives so that the parties clearly understand the terms and conditions of the final contract. The Analyst reports to the Supervisor of Enterprise Reinsurance, the Director of Enterprise Underwriting and the Vice President of Actuarial Services. This position’s principle contacts within the corporation are the Enterprise Underwriting staff, the Regional Offices, the Actuarial Division, Customer Accounts, Systems, Legal, Claims. The incumbent’s principle contacts outside the company are Excess Loss Carriers, Agent/broker/consultants, and group customers. Job Description: Principal Responsibilities 1. Assist in underwriting and coordinating self-insured groups in accordance with excess loss parameters and department standards. 2. Prepare documentation of underwriting for new groups and renewals. 3. Track and report excess loss premiums, renewal and quote activity. 4. Track and evaluate renewal standards. 5. Prepare excess loss proposals. 6. Provide timely and accurate responses to carrier, marketing, and group inquiries. 7. Assist marketing and regional staff with reports and data requirements to make informed decisions. 8. Maintain excess loss database. 9. Assist marketing in a consulting capacity regarding fully and self-insured groups. 10. Monitor groups utilization to determine claim filing. 11. Order all necessary documentation to submit claim. 12. Track claims reimbursement. Job Specifications The Analyst I must have knowledge of the health insurance market in general. The position requires the ability to understand medical underwriting and rating issues. The incumbent must be able to interpret contract and plan document language. The Analyst will monitor the changing rules and regulations from the regulatory organizations including the U.S. Department of Labor, State Insurance Department, Blue Cross and Blue Shield Association. The Analyst I must have or obtain within 12 months of hire an insurance agent license as part of the requirements of the position. The Analyst will use their knowledge and job skills to request quotes from the excess loss carriers. To do so, the analyst must understand the requirements of the excess loss carriers and assist the customer in obtaining a contract. This includes gathering and submitting the required documents of a self-funded plan, the gathering and providing of financial and claims data required by the carriers; and helping the customer in establishing the processes and procedures to manage the contract. The Analyst will work with the various vendors associated with the enterprise to obtain quotes for the excess loss coverage. The analyst will submit the quotes to the Analyst II or III for review. In addition, the analyst will work with marketing staff in analyzing competitive quotes and preparing presentations to potential customers. As such, the analyst plays a consulting role for the marketing staff and the self-funded customer. In performing the quoting role described above, the analyst must have a general understanding of the medical underwriting process, as well as medical terminology, and the application of medical information to the rating process. The Analyst will monitor the reinsurance contract on behalf of the group customer. This includes ensuring that all reporting is completed accurately and submitted timely to maintain divisional standards. The analyst must be able to travel to conduct training sessions and maintain the industry knowledge requirements of the job. Other responsibilities will include participating in marketing training sessions, attending meetings and special projects as directed by the Director of Enterprise Underwriting. Education & Experience: Bachelor's degree in business administration, organizational management, insurance, finance, accounting, mathematics, or statistics. Prior underwriting or actuarial experience is a plus. Specialized Knowledge & Skills Proficient knowledge of Word, Excel, Access and PowerPoint Competencies Decision making skills on sound evaluation and analytical processes. Security Requirements This position is identified as level three (3). This position must ensure the security and confidentiality of records and information to prevent substantial harm, embarrassment, inconvenience, or unfairness to any individual on whom information is maintained. The integrity of information must be maintained as outlined in the company Administrative Manual. Segregation of Duties Segregation of duties will be used to ensure that errors or irregularities are prevented or detected on a timely basis by employees in the normal course of business. This position must adhere to the segregation of duties guidelines in the Administrative Manual. Employee Regular Number of Openings Available: 1 Arkansas Blue Cross Blue Shield is an Equal Opportunity Affirmative Action employer and is subject to federal regulations pertaining to employment.Arkansas Blue Cross does not unlawfully discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity or expression, national origin, age, disability, marital status, veteran status, or any other basis prohibited under federal, state or local laws governing non-discrimination in employment in every location in which the Company has facilities. Arkansas Blue Cross also provides reasonable accommodations for qualified individuals with disabilities in accordance with the Americans with Disabilities Act (ADA) and any other state or local laws.