Healthcare Director of Underwriting and Pricing

posted on June 28, 2018

Job Description

Location: Boston, MA

Type: Permanent

Position Summary:

  • The Director of Underwriting and Pricing is responsible for providing critical support to the Executive Leadership team in the development of strategies to achieve key financial and membership goals.
  • This leader is responsible for the evolution and maintenance of the client’s underwriting business plan and strategy while directing the underwriting team to achieve these objectives.
  • This position will collaborate with internal business partners to enable this outcome and will serve as a project leader for key interdepartmental initiatives to support future success.
  • They are also responsible for the development and clear presentation of key underwriting statistical metrics to ELT while also providing guidance and support in financial analysis and interpretation in support of strategic decision making.
  • The successful performance of this role requires effective interaction with brokers, the Division of Insurance, Connector, and MAHP.
  • In addition, this position will have external-facing responsibility by meeting with new and existing clients.
  • The Director of Underwriting and Pricing will also develop and enhance the reputation of the client in the market by visiting insurance brokerage companies and attending industry conferences.

Underwriting and Pricing (25%):

  • Provides overall direction and guidance to the Underwriting Team, and is responsible for:
  • Oversight of more than $700 million in revenue for 115,000 members
  • Achieving the annual corporate membership and underwriting margin goals by developing pricing and product strategies
  • Define corporate group underwriting policies and practices
  • Support cross functional projects, initiatives and committees.
  • Setting case level and market level strategies to win and retain business for long term growth and financial stability.
  • Oversight of Commercial group enrollment and benefits functions, Medicaid, and Medicare rate process
  • Development and ownership of a suite of metric reporting for ELT to use for critical decision making
  • Responsible for corporate reinsurance contract and annual negotiations
  • Partner closely with the New and Existing Business Sales Leadership Team
  • Provide support for new sales and revenue growth targets to maximize market penetration
  • Lead external meetings for brokers and prospective and current employer groups
  • Attend quarterly key broker employee benefit meetings
  • Training to ensure that Sales has a detailed understanding of all products and solutions

Strategic and Tactical Plans (20%):

  • Collaborates with ELT and sales leadership teams to develop and implement strategic and tactical plans in alignment with corporate membership and revenue goals
  • Develops & executes annual business plans, project initiatives, department budgets and key performance indicators.
  • Active member of Executive Steering Trend committee, Commercial Product Steering committee, Market Pillars team, and ASO Stakeholders committee
  • Consult with Business Development on new products and plan designs and market intelligence

ASO and Reinsurance (15%):

  • Drive development and ensure effective execution and implementation of a complete Stop Loss business strategy
  • Identify, evaluate and monitor alternative funding arrangements, captives and products
  • Oversees the client’s stop loss vendor relationship management and processes to ensure effective partnerships with quality reinsurers and identifies opportunities to strengthen the relationship
  • Develop key strategic partnership opportunities to drive additional membership, revenue, and margin

Resource Management (20%):

  • Provides strategic direction & leadership to promote an engaged and high performance work culture.
  • Attracts, coaches and develops talent to ensure a staff capable of carrying out business strategies while also enhancing the client’s bench strength.
  • Drive team to operate with greater analytic and strategic focus
  • Forecasts changing business needs and aligns team structure, skills and experience to provide career development opportunities and ensure the internal talent pool is deployed to their fullest extent
  • Succession planning- provides coaching for direct reports to be in position to grow into roles of greater responsibility and offer stretch assignments for further growth.
  • Leads change by communicating vision and gaining commitment of staff.
  • Contributes to success by creating departmental and individual staff goals, measuring results, evaluating performance, rewarding achievement or taking corrective action, as necessary.

Change Management and Innovation (10%):

  • Develop and/or encourage new ideas, process improvements, operating protocols, and quality assurance programs and approaches
  • Continuously looks for opportunities to maximize cost effectiveness through innovation, negotiation, integration and business process improvements.
  • Drive cross functional team dynamic to implement system automation for rate and benefit data entry as well as employer reporting

Project Management and Regulatory (10%):

  • Proactively communicate with key business leaders across the organization to keep all interested parties updated on progress made and results achieved.
  • Effectively influence cross-functional teams across a broad range of functional areas to enable development and execution of key corporate projects.
  • Promotes organization-wide understanding, communication, education and coordination of all federal and state regulatory requirements related to ACA and Division of Insurance
  • Quarterly rate filing support
  • DOI and internal audits
  • Connector and Intermediaries
  • Financial Reporting (such as changes to market segments)

Minimum Requirements:

  • Bachelor’s Degree in Business, Finance, Economics, or a related field and more than 7 years of advance level underwriting experience preferable from managed care or health insurance, or an equivalent combination of education and experience.
  • 5 years of management experience with a strong business and financial acumen
  • Demonstrated experience in successfully managing external relationships
  • Knowledge of State and Federal legislation to group health underwriting
  • Professional certification highly preferred
  • Academy of Healthcare Management (PAHM), Registered Health Underwriter RHU), Health Insurance Associate (HIA), or Certified Employee Benefits Consultant (CEBS)
  • Strong computer skills including proficiency with Microsoft Office Suite
  • Excellent mathematical, analytical, and quantitative skills with great attention to details
  • Strategic understanding of the changing business environment and how to adapt the company’s approach to achieve success with intellectual curiosity to delve into various business problems
  • Strategic, collaborative, high sense of urgency and action/growth oriented
  • Proven leadership skills including coaching, mentoring, recruiting, & professional development
  • Problem solver with the ability to encourage others in collaborative problem solving
  • Strong communications and presentation skills
  • Ability to work well with others to achieve shared goals while demonstrating diplomacy and flexibility
  • Ability to manage multiple projects & timelines across a variety of stakeholders to meet deadlines


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