Experience

• 

  Granular Insurance

  • Panama
  • Insurance
  • 1 - 100 Employee

  • Stop Loss Underwriting Manager

    • Jan 2023 - Present

    •Assess applications, determine overall risk, and price business•Negotiate coverage structure, terms and similar account parameters and bind business•Mentor and guide junior underwriters on complex submissions•Assist in the development and implementation of competitive underwriting strategy•Serves as a subject matter and process expert•Continually improves underwriting and pricing procedures and implements revisions to existing policies•Promotes and ensures underwriting and pricing consistency•Develops and provide training about health insurance industry to underwriters and company personnel.

  • Senior Stop Loss Underwriter

    • Jul 2021 - Dec 2022

    •Evaluate, price and propose rate and strategy on Stop Loss new business within stated authority limit.•Manage assigned workload to meet internal productivity •Formulate a successful strategy to write cases within general underwriting guidelines•Independent decision making on fundamental problems within specific rules and utilizing general underwriting guidelines•Resource for other underwriters •Analyzes information on industry, demographics, and other standard criteria•Work effectively in a high volume, transaction-oriented environment•Determines level of risk based on well established guidelines•Quotes appropriate rates to field agents or brokers•Build and maintain effective working relationship with assigned inside sales specialists and brokers•Ensure there is effective support to inside sales by acting as a full team member and providing critical support as needed to all phases of the sales process.•Input customer logistics to enable generation of the quote•Identify and obtain missing information material for assessment and/or pricing of the risk•Verify customer information within the system to ensure accuracy•Supports the identification and development of best practices work flows and procedures•Provides technical support•Prepare and provide training sessions about health insurance industry concepts to underwriters and company personnel.

• 

  Group Benefit Services

  • Springfield, Missouri

  • Stop Loss Specialist

    • Oct 2015 - Jul 2021
    • Springfield, Missouri

    • Timely and accurate filing of specific and aggregate claims.• Monitoring and updating supporting submission materials • Analyze, process, research and adjudicate claims with the use of accurate procedure/revenue• Specific and Aggregate claims filing based upon contractual agreements, involving use of established payment methodologies, applicable regulatory legislation, plan document guidelines, claims processing guidelines and company policies and procedures.• Alerts management of issues that impact filings, production and quality• Maintain quality and productivity standards as set by management• Maintaining compliance with PHI and HIPAA requirements

• 

  Medical Card Systems Inc.

  • Puerto Rico
  • Insurance
  • 700 & Above Employee

  • Group Health Underwriter Manager

    • Jul 2008 - Aug 2014

    • Manage the rate calculation for small and large employers both new business and renewals using different funding methods such as fully insured and self-insured with and without reinsurance. • Recommend modifications to policies and procedures. • Evaluate the risk presented by each account due to any past or prospective changes, and adjust rates to reflect the change in risk. • Support sales, brokers and account executives in the new business, renewals and customer management process as technical expert. • Establish cost containment measures such as PPO Networks, specialized networks, bill review and reinsurance. • Evaluate reinsurance contracts for the commercial portfolio as well as for the self-insured employers. • Monitor reinsurance book of business loss ratio.• Manage all aspects of reinsurance and PPO Networks from preparing the Request for Proposal, negotiation and coordinating the implementation of the contract terms with the operational areas.

  • Group Health Underwriter

    • Jan 2001 - Jun 2008

    • Responsible for the rate calculation for small and large employers both new business and renewals using different funding methods such as fully insured, self-insured with and without reinsurance. • Evaluate the risk presented by each account due to any past or prospective changes, and adjust rates to reflect the change in risk. • Evaluate reinsurance contracts for the commercial portfolio as well as for the self-insured employers. • Support sales, brokers and account executives in the new business, renewals and customer management process as technical expert.

  • Statistics Technician

    • Sep 1999 - Dec 2000

    • Provide data mining and statistical support as needed for business units, operations, and other functional areas.  • Analyze, interpret and validate data in systems to provide information to decision makers.• Report changes in membership for new business, renewals and the book of business by funding method.

• 

  Cooperativa de Seguros de Vida

  • San Juan, Puerto Rico

  • Actuarial Technician - Accident

    • Feb 1996 - Feb 1997
    • San Juan, Puerto Rico

    • Provide data mining and statistical support as needed for business units, operations, and other functional areas.  • Analyze, interpret and validate data in systems to provide information to decision makers.• Quote accident policies and report premiums to management.