Portland State University - School of Business

Analytics Consultant II at Premera Blue Cross

Premera Blue Cross

Analytics Consultant

•	Evaluate and develop rates and accept or reject risk after examining appropriate information required to underwrite prospects and renewals for all funding types and market sizes.
•	Review requests for alternative funding arrangements and alternate benefit packages to determine feasibility and anticipated risk impact.
•	Develop and present materials to internal and external customers.
•	Develop and enforce underwriting guidelines and rules and administrative rules.
•	Develop and maintain strong relationships with internal and external partners.
•	Utilize applications to support the rating and underwriting process.
•	Recommend solutions to improve documents, systems, and processes related to rating and data analysis.

Senior Large Group Underwriter

Large Group Underwriter

•	Set priorities and manage analytical work flow to ensure efficient, timely and accurate creation of deliverables.
•	Responsible for the financial analytics for clients that are fully-insured and self-funded.
•	Prepare standard analyses, in accordance with client service calendar financial meetings. 
•	Analysis of funding projections, claims utilization, and rates and plan benefits in order to consult with internal partners and offer solutions for external clients.
•	Utilize standard analytical tools, checklists and templates. 
•	Serve as primary contact with insurance carriers for marketing coverage for new business quotes and renewals, including requesting quotes, evaluating and spreading options, conducting fact-based negotiation of rates and benefit features.
•	Develop alternative strategies, plan modeling and cost reduction opportunities.
•	Independently write client facing Executive Summaries that provides observations and findings. Suggest recommendations and next steps for review by producer or account manager.
•	Maintain strong relationships with internal partners and external carrier partners; leverage partnerships to drive negotiations on behalf of clients.

Kibble & Prentice

Benefit Analyst

Evaluate and accept or reject risk, after examining appropriate information required to underwrite new applicants, and application for plan changes. Includes review for completeness, accuracy and conditions for acceptance of the risk. 
Completes analysis of medical conditions using actuarial formulas to determine the expected risk for prospective enrollees. Evaluates calculations for reasonability, by analyzing medical conditions, physician and hospital records, claims history and prescription drug data and patterns, determining eligibility, identifying unusual or inconsistent information, and potential liability resulting from underwriting the risk. 
Review requests for changes in benefit plans to determine anticipated risk impact, apply actuarial and other adjustment factors relative to the risk. 
Update and approve all required systems and forms, and communicates to Sales, Marketing, Operations, Contracts, and Finance, as required.  
Use mainframe and PC applications to support the rating and underwriting process, including administrative systems, claims reporting, reporting databases, care facilitation, etc. 
Communicates in a professional manner with internal departments such as Sales and Marketing, Operations, Contract Services, Membership Services, Information Technology, etc.  
Monitor and direct activities on case specific issues and/or projects. 
Perform other duties and special projects as assigned, including participation in corporate projects and initiatives. 
Test system(s) updates before and after implementation.  Troubleshoots/tests errors/updates with Underwriters, Actuaries and others. Recommends solutions and documents procedures/processes for various rating and other administrative systems.
Accountable for eligibility appeal decisions, approval of changes in contract wording, application and other general underwriting exception requests, for assigned cases.

Medical Underwriter

Responsible to create and maintain formal audit system tools and procedures to ensure adherence to Underwriting policies, regulations, rating formulae and membership eligibility guidelines.
Summarize audit results, resolve discrepancies with Sales/Underwriting areas, initiate corrective action as necessary, and submit reports for management review.
Evaluate existing enrollees to detect errors or omissions made in the health statement process, request and review medical records for error determination.
Analyze data from competitors and present statistical summaries to leadership.
Collaborate with Sales teams (WA, OR and AK) to create solutions that serve the needs of the customer while maintaining an equitable balance between risk and rates.
Monitor compliance for adherence to eligibility guidelines. At request, determine if exceptions can be made without undue additional risk.
Analyze and interpret utilization claims and financial data to make assumptions and develop reports and exhibits in support of recommendations.

Christina Petersen