Remote Fraud Risk Management Jobs in Portland, OR

Vice President of Stop-Loss Underwriting

Work a remote work schedule.

Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.

Who We Are Looking For:

Every day, Cambia's dedicated Stop Loss is living our mission to make health care easier and lives better. As a leader of the Stop-Loss Underwriting team, our VP of Stop-Loss Underwriting manages stop loss book of business risk selection and risk classification activities to meet top line growth and bottom-line profitability objectives. Cambia-wide final decision maker for stop loss concessions on rates and terms prior to escalation. Plans, develops and directs the activities of the Underwriting Stop Loss departments within Cambia to meet corporate objectives for stop loss risk management, renewal activity, and new business production. Secures necessary capabilities for stop loss business in total; e.g, premium and billing system, reporting system, UM/CM capabilities in/outsourced, etc. Actively engages with state insurance departments to initiate and/or resolve filing issues. Drives process to evaluate and approve external Third-Party Administrators. Represents Cambia and CBRM in AM Best presentations - all in service of creating a person-focused health care experience.

Do you have a passion for serving others and learning new things? Do you thrive as part of a collaborative, caring team? Then this role may be the perfect fit.

What You Bring to Cambia:

Qualifications:

Vice President, Stop Loss Underwriting would have a Bachelor's degree in business, math, statistics or related discipline and 12+ years underwriting experience in the health insurance profession with specific responsibilities in stop loss or equivalent combination of education and experience.

Skills and Attributes:

Develops strategies to meet the corporate goals for contribution to reserves by line of business through rating, reimbursement and risk management strategies.

Establishes quote authority limits for all stop loss underwriters.

Reviews and Signs-off on all cases above the underwriter's quote authority limits and all exception cases.

Responsible for the development and maintenance of the Underwriting Guidelines, annual stop loss underwriting audits of all underwriters, and oversight of the stop loss contracts.

Directs development and implementation of policies and procedures in compliance with corporate strategies and legislative mandates.

Directs the development and application of equitable and competitive rates to group to assure favorable underwriting.

Directs the development and implementation underwriting policies that preclude adverse selection and provide the opportunity of coverage to specified communities.

Maintains an optimum balance between an adequate rate structure and stop loss coverage that is competitive in the marketplace.

Provides support and analysis to the Senior Vice President and Chief Actuarial Officer.

Monitors and recommends changes to manual rate and factor development to ensure optimal outcomes for sales, renewals, and underwriting gain.

Leads a team of Managers, Stop Loss Underwriters, Stop Loss Claims Analysts, Medical Risk Consultants and support personnel. Directs work product and production of assigned stop loss underwriting nurse staff.

Demonstrated ability to leverage AI tools and resources to drive efficiency and innovation within Stop-Loss Underwriting.

What You Will Do at Cambia:

Demonstrated ability to read the self-funded employer stop loss marketplace with regards to rate sensitivity and product offerings.

In-depth knowledge of the health care industry and specifically in the self-funded employer stop loss market; including underwriting principles, alternative funding models, administration, market and regulatory requirements.

Demonstrated competency to think analytically, apply analytical techniques and to provide in-depth analysis and recommendations using critical thinking and sound judgment.

Demonstrated competency to apply and interpret quantitative data for decision-making.

Demonstrated competency working with complex computer software systems.

Strong knowledge with complex mathematical concepts and ability to communicate abstract concepts to lay personnel.

Demonstrated competency in effective communication, verbally and in writing, with all levels of the work force.

Demonstrated competency to establish and maintain effective working relationships with executives, managers, supervisors, sales professionals and brokers.

Demonstrated ability to work with all levels of the staff and management both as a self-starter and in a team environment.

Demonstrated ability to promote new visions and ideas and gain "buy in" from senior leadership, management and peers.

Strong knowledge in planning, organizing and leading the work of others with minimal supervision, while developing departmental goals and objectives consistent with corporate vision and strategies.

Ability to coach and develop Stop Loss Underwriting Managers.

Demonstrated ability to leverage AI tools and resources to drive efficiency and innovation within area of expertise

FTE's Supervised

8-12, 2 Managers

Work Environment

No unusual working conditions.

The expected hiring range for a VP Stop Loss Underwriting is $238,900.00 - $323,200.00, depending on skills, experience, education and training; relevant licensure / certifications; performance history; and work location. The bonus target for this position is 31.25%. The current full salary range for this role is $224,000.00 - $366,000.00.

About Cambia

Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.

Why Join the Cambia Team?

At Cambia, you can:

• Work alongside diverse teams building cutting-edge solutions to transform health care.
• Earn a competitive salary and enjoy generous benefits while doing work that changes lives.
• Grow your career with a company committed to helping you succeed.
• Give back to your community by participating in Cambia-supported outreach programs.
• Connect with colleagues who share similar interests and backgrounds through our employee resource groups.

We believe a career at Cambia is more than just a paycheck - and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more.

In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include:

• Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
• Annual employer contribution to a health savings account.
• Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
• Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
• Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
• Award-winning wellness programs that reward you for participation.
• Employee Assistance Fund for those in need.
• Commute and parking benefits.

Learn more about our benefits.

We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.