Student Health Insurance Plan Manager - Hybrid Office/Home

GENERAL PURPOSE

With general oversight from department leadership, the Manager is primarily responsible for the financial management and monitoring of the health plan including financial reporting, analysis, development of monthly and annual reporting for internal and external (state and federal agencies) stakeholders, financial accounting systems, measurement and performance of the health plan to University senior leadership and stakeholders, as well as New York State Department of Financial Services (NYS DFS). This position also serves as a content expert on the ever-evolving NYS DFS financial and accounting requirements pertaining to student health insurance plans and overarching requirements of health insurers. In addition, this position is responsible for educating, advising, and counseling faculty, staff and students regarding regulatory matters and associated financial impact. The Manager supports the Compliance and Risk services by using financial data proactively and accurately; reviewing reconciliations for timeliness and accuracy; preparing monthly and annual financial reports for management and audit purposes; and synthesizing data for trend analysis. The responsibilities of the Manager are accomplished through the development of compliance and risk management matrices for the endorsed certificates of coverage including improving Student Health Insurance Plan (SHIP) business processes that support timely, accurate mitigation and action plans relating to insurance laws and regulatory requirements as well as university policies and procedures.

The Manager is responsible for synthesizing financial data for trend analysis including premium rate setting, reserve setting, and developing a financial strategy that limits premium increases to the students. This position maintains several relational data systems and business decision models based on claims and utilization data. Using these systems, economic market theory, research and regulations the Manager:

• develops strategies for managing changing consumer utilization and population driven health solutions based on demand and market functions;

• identifies highly complex emerging risks;

• develops evolving mitigation efforts on behalf of the university; and

• develops risk-based solutions that are sustainable over time.

Additionally, this position is responsible for educating, advising, and counseling staff regarding financial regulatory matters. The responsibilities of the SHIP Manager are accomplished through the development and maintenance of strong financial, reporting, and data driven practices including improving SHIP business processes that support timely, accurate reporting relating to insurance laws and regulatory requirements, management of FASB standards, as well as university policies and procedures.

SPECIFIC RESPONSIBILITIES:

Financial Compliance Oversight

• Functions as the primary contact and manager for all financial submissions and inquiries to NYS DFS, including the statutory examination.

• Monitors all accounts related to the Student Health Plan according to the accounting methodology and University standard. Reports all anomalies to the department leadership and SHIP Oversight Committee. Proposes and/or implements any solutions according to agree upon business processes.

• Assists in the development of business processes and strategies that improve solvency of the plan with a focus on member retainment and satisfaction.

• Provides oversight of financial dashboards and member utilization.

• Acts as the subject matter expert on all federal and state regulations associated with financial requirements for student health plans.

• Assists with the development of eligibility standards and practices including business rule logic functions associated with eligibility, SOPs associated with enrollment, and correspondence with units and colleges around enrollment in support of the certificate of coverage.

Reconciliation Review & Data Analysis

• Synthesizes data for trend analysis. Develops reports and analysis to make recommendations for insurance coverage using underwriting information and coverage placement, claims administration, benefit design, loss forecasting, and loss reduction. Prepares annual financial statements and other statutory reports and forms. Models plan design changes and prepares data reports for oversight committees and other University groups. Assists with annual reports in conjunction with department leadership.

• Reviews enrollment & claims reconciliations for timeliness and accuracy. Prepares monthly financial reports for management. Documents operational policies and proposes changes as needed to mitigate risk.

• Synthesizes financial data for trend analysis including but not limited to: insurance reserves; premium setting, third party services, operating costs and resource needs.

Plan Development, Oversight & Reporting

• Assists in preparation and execution of examinations with governmental officials and respond back to inquiries as appropriate on behalf of the University. Coordinates with other departments across the University as directed by supervisor.

• Prepares annual footnote for University financial statements and perform other year-end close activities. Synthesizes data for annual report and presentations for the Board of trustees, and senior leadership such as: EVP, Central Finance and Internal Audit.

• Synthesizes data for annual report and presentations for the Board of trustees, and senior leadership such as: SHIP Oversight Committee, EVP and Internal Audit.

• Manages processes and products from actuary, CPA, third party audits, etc.

• Monitors and reports on audit findings, examination findings and implemented mitigation strategies associated with those findings.

• Participates in strategy development for the student health insurance plan focusing on cost reductions, risk mitigation, insurance policies, guidelines, and standards.

• Assists in developing insurance eligibility standards and practices.

• Provides guidance and support to health plan enrollment partners.

• Provides information and support for broader university finance and compliance functions.

Risk Management & Compliance

• Oversees plan risk analysis and overall enterprise risk management.

• Responsible for fraud assessment & compliance.

• Develops internal control processes and reports on performance.

• Conducts cybersecurity analyses and develops processes to ensure continued compliance.

Human Resource Oversight

• Supervises Student Health Insurance Plan staff including recruitment, training and oversight of staff performance

Other duties as assigned

REQUIREMENTS:

Bachelor's degree (Accounting or Finance preferred) required

Master's or other professional degree in related business field (e.g. MBA or MHA,)

5 to 7 years of experience or equivalent and experience in accounting or equivalent experience in relevant financial monitoring and reporting experience required.

Financial experience in University or Academic Medical Center preferred

Required specific knowledge, experience and skills should include:

• Financial accounting

• Financial Analysis

• Attention to detail

• Ability to work independently with minimal supervision

• Demonstrated leadership ability

• Highly effective written and oral communication skills

• Experience using and managing relational databases

Preferred specific knowledge, experience and skills:

• Experience with health plan analytics and/or developing complex analytical models.

• Experience preparing financial statements.

• Experience managing audits and working with auditors.

• Experience interacting with regulatory agencies related to health services, finance or insurance.

Experience working in a university setting and/or working student specific health plans/products.

CPA (Certified Public Accountant) preferred

The University of Rochester is committed to fostering, cultivating, and preserving a culture of equity, diversity, and inclusion to advance the University's mission to Learn, Discover, Heal, Create - and Make the World Ever Better. In support of our values and those of our society, the University is committed to not discriminating on the basis of age, color, disability, ethnicity, gender identity or expression, genetic information, marital status, military/veteran status, national origin, race, religion/creed, sex, sexual orientation, citizenship status, or any other status protected by law. This commitment extends to the administration of our policies, admissions, employment, access, and recruitment of candidates from underrepresented populations, veterans, and persons with disabilities consistent with these values and government contractor Affirmative Action obligations.

How To Apply

All applicants must apply online.

EOE Minorities/Females/Protected Veterans/Disabled

Pay Range

Pay Range: $68,400 - $102,600 Annually

The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job's compensation range, and will be determined by considering factors including, but not limited to, market data, education, experience, qualifications, expertise of the individual, and internal equity considerations.

Pay Range

Pay Range: $68,765 - $103,147 Annually

The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job's compensation range, and will be determined by considering factors including, but not limited to, market data, education, experience, qualifications, expertise of the individual, and internal equity considerations.

Apply for Job

• Careers

• Sign In

• New User

Location: Central Administration
Full/Part Time: Full-Time
Opening:
Schedule: