Underwriting Specialist II

Position Description

Base pay is influenced by several factors including a candidate’s qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market driven rates. The salary range displayed has not been adjusted for geographical location. This range has been created in good faith based on information known to Capital Blue Cross at the time of posting and may be modified in the future. Capital Blue Cross offers a comprehensive benefits packaging including Medical, Dental & Vision coverage, a Retirement Plan, generous time off including Paid Time Off, Holidays, and Volunteer time off, an Incentive Plan, Tuition Reimbursement, and more.  

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.”    

This position primarily performs underwriting audits of new non-large group customers and select existing non-large group customers. Staff members reach out to external producers, employer group decision makers and various internal business units to collaborate on the evidence submitted to satisfy all of the requirements of the UW Compliance guidelines.

After evaluation, the specialist communicates audit outcomes with employer groups and producers.

Responsibilities and Qualifications

• Performs an underwriting audit of all new group business & risk pool changes according to unit procedures. Documents audit progress appropriately and protects PHI. Accurately identifies changes in census between quote and final enrollment.
• Performs an underwriting audit of existing group customers selected for audit. Sends letters to groups and producers notifying them of the audit and requesting required documents. Outreaches to employer groups or external producers for additional information as needed according to unique requirements of the case. Communicates audit outcomes to the customers and producers. Documents audit progress appropriately and protects PHI.
• Performs validation of products on orders submitted for change - on or off renewal cycle, according to published UW guidelines, collaborating with management as necessary for more complex cases. Documents completion by adding a note to the electronic record in the Sales System.

Skills:

• Ability to communicate professionally and effectively, both orally and in writing, with external group customers, producers, and other Plan personnel on a regular basis.
• Ability to draft modifications to templated language to meet the unique business cases.
• Ability to adapt independently to changing workloads, assignments and priorities using good organizational, analytical and problem-solving skills.
• Ability to compare multiple documents to identify differences between them and identify potential gaps or inconsistencies in the information provided.
• Ability to analyze documents and extract required information.
• Ability to learn how to use new software programs to increase work efficiency
• Use of MS Word, Excel, Outlook, Teams, Salesforce, Facets, and Nuance PDF

Knowledge:

• Knowledge of Capital’s Underwriting guidelines and the general principle of risk selection.
• Knowledge of Enrollment & Billing and Marketing/Sales guidelines.
• Knowledge of all non-large commercial group products and associated lines of business sold by Capital and how their enrollment requirements interact with each other.
• Knowledge of basic mathematical and statistical concepts gained through work experience in a business setting.
• Familiarity with Capital’s organizational structure and operations.

Experience:

• Minimum 1 years' experience as Underwriting Specialist I.
• Prior office / business work experience required, preferably in the healthcare industry.

Education and Certifications:

• Must have a high school diploma or G.E.D.

Physical Demands:

• While performing the duties of the job, the employee is frequently required to sit, use hands to finger, handle and feel, and talk, hear, and see.
• The employee must be able to work over 40 hours per week.
• The employee must occasionally lift and/or move up to 5 pounds.

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.