Review and manage small group and SB ASO renewals as well as requests for rate relief and manage the adjustments to achieve overall financial targets. Manage adjustments to mid-market-sized prospect groups based on prior carrier experience, historical rate actions, and/or Capital’s previous experience. Manages the process of calculating customer settlements. Manages the completion of Schedule A and Schedule C reports to customers, as applicable. Evaluates process flows for efficiency and opportunity for automation as well as need to change due to corporate or UW business needs, market trends or regulatory requirements. Assures high performance levels are met through activities including recruitment and development of staff through education, mentoring and coaching. Serves on corporate committees and work groups, as necessary, to provide input for corporate initiatives.

• Manage the underwriting of non-large (small group and SB ASO) to generate financial results in line with the corporate budget.  This includes both new business and renewals.
• Make business decisions in response to Sales’ requests for rate relief mid-market and SB ASO customers or prospective customers.
• Represent UW/Actuarial departments on various corporate committees and project teams as appropriate
• Calculate and ensure the accuracy of customer financial settlements for both applicable large groups as well as all SB ASO groups.
• Evaluate Process flows to react to changes in business needs and to implement process improvements 
• Complete Schedule A reporting for group >100 and Schedule C reporting for ASO groups upon request.  Manage the requirements and data feeds into said reports.
• Serve as business owner of the Home and Host plan Value Based Benefits.
• Manage People
• Recruit and Develop staff
• Supervise the quality of performance of UW Compliance staff performing group audits and related activities - motivate to meet or exceed goals while maintaining adherence to relevant policies
• Manage miscellaneous financial transactions, including but not limited to NYHCRA fees for ASO groups, payment of Vermont taxes and generation of CBF records for non-standard fees and MA Coordination of Care fees.

Leadership:

• Requires demonstration of leadership skills including motivating, scheduling and enhancing collaboration across cross-functional teams and/or focused work groups.
• Persuasion and negotiation skills to resolve differences with skill and understanding.
• Ability to act as a liaison and recommend solutions to a variety of departments as well as external entities.
• Ability to perform duties with minimal supervision.

Experience:

• Minimum 5 years’ experience related to the principles of risk selection.
• Minimum 1 year experience as a project/team lead.

Skills:

• Must possess effective verbal and written communication skills.
• Must possess strong quantitative analysis skills to evaluate rate change requests.
• Must be proficient with MS Word, Excel, internet searching and web-based tools.
• Experience in Salesforce, MARIS and Stepwise a definite plus.

Knowledge:

• Understanding of Capital Blue Cross corporate structure including knowledge of standards and policies, business practices and procedures.

Education, Certification, and Licenses:

• Requires a bachelor’s degree or equivalent work experience in health insurance or health care industry.
• Maintain a professional level of competence through continued education and exposure to technologies/methodologies.

Travel Requirements:

• Infrequent potential off-site meeting locations or training.

Physical Demands:

• While performing the duties of the job, the employee is frequently required to sit, use hands and fingers, 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.

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.