INSURANCE FUND MANAGER
DEFINITION OF CLASS:
This is administrative, financial management, and analytical work overseeing and coordinating all operations of either the County's Group Insurance Fund or the County's Self Insurance Fund. The work involves fiscal review, planning, reporting, and advisory services contributing to the financial stability, operational and procedural soundness, and efficiency of the assigned Insurance Fund for the County Government and component agencies. Personal contacts include respective Group Health or Self Insurance Fund participants (i.e., department directors and staff of County departments); representatives of the respective insurance plan provider organizations; financial management, claims, and/or actuarial consultants; and/or union, employee, and retiree representatives. The purpose of these contacts is to provide subject matter expertise, advice, and recommendations; to present and defend matters of substantive, far-reaching significance and/or controversy to top County decision-makers; to coordinate collaborative efforts; and to request from or provide information to a number of different individuals/organizations with a stake in the respective Group Health or Self Insurance Fund. This class of work may entail some public service/assistance, but it is incidental to the primary focus of the work performed.
The employee in this class is responsible for administering either the Group Insurance Fund or the Self Insurance Fund; preparing and/or assessing financial and cost analyses reports; determining fiscal and functional impact of new/modified policies, requirements, and/or laws; analyzing/auditing and assessing current and revised procedures and methods used to create financial reports, maintain data, and process claims payments and/or other types of fiscal transactions; analyzing benchmarks with other self-insured public entities; evaluating trends in self-insured claims and recommending appropriate mitigation strategies; and, coordinating and resolving issues that arise regarding the administrative and financial aspects of managing the assigned Fund. The employee has full technical responsibility for the work and proceeds independently to plan and carry out the work, collaborating with internal and/or external stakeholders, as appropriate. For the Group Insurance Fund this collaboration includes staff and managers from other County departments who have involvement in various phases of the Fund administration, i.e., enrollment, database administration, billing and payment, financial accounting and reporting, annual premium and rate setting, fiscal and budget planning, and contract monitoring. For the Self Insurance Fund this collaboration includes participating County departments and agencies concerning funding, budget, and expense matters, as well as contractors providing ongoing claims auditing services and the annual actuarial study. Work results are reviewed in terms of effectiveness in meeting objectives. Guides governing the work include established generally accepted principles and methods of accounting, financial reporting, and statistical analysis, particularly as applicable to analyses of calculations common to the respective insurance industries (i.e., health care insurance or municipal self-insurance); financial and other factors impacting the health or self-insurance industry and cost trends; public sector budgetary procedures, methods, and techniques; computer system applications and processes related to insurance fund financial accounting and reporting; and, general contract management processes and procedures. Job complexity derives from planning, organizing, and coordinating the administrative aspects of managing the respective Group Insurance or Self-Insurance funds which are large, complex, and active; generating and interpreting statistical analyses and financial reports and assuring that the data and the conclusions represent appropriate and accurate measurements to monitor the health, stability, cost, and utilization of the respective Fund; and developing new, improved methodologies, techniques, and analytical efforts as necessary to assure completeness, reliability, and accuracy of data, reports, operational processes, conclusions, and recommendations. The scope and effect of the work are substantial in that they involve administrative responsibility for the health and stability of a major County Fund (i.e., the Group Insurance Fund provisions health and life care insurance for County active and retired members; the Self-Insurance Fund provisions property and casualty insurance for the County and participating agencies). The transactional flow of data related to the respective Insurance Funds and the operational procedures generated for their utilization/management involve numerous departments within the County as well as external agencies that the employee must be cognizant of when collaborating and coordinating Fund administration activities, policies, and procedures. The work is primarily sedentary, performed in a typical office setting, and presents no significant hazards.
EXAMPLES OF DUTIES: (Illustrative Only)
Group Insurance Fund Manager:
Provides administrative and financial oversight to the County's Group Insurance Fund; prepares and/or assesses statistical analysis, financial reports, and other analytical measurements that exist in the health care industry to monitor the Fund's stability and health; compares a variety of different data from the County's insurers/administrators to national and state benchmarks to identify/support improvements in administration and/or utilization of the Fund.
Collaborates with and convenes regular meetings with key staff from the Finance Department, Office of Management & Budget (OMB), Office of Human Resources (OHR), and Department of Technology Services for the purposes of reviewing and improving transaction processing, identifying and resolving substantive/procedural problems in various phases of fund administration (i.e., enrollment, database administration, contract performance, billing/payment, reporting); improving communication and coordination; and reaching consensus and making staff recommendations to department directors concerning major and/or far-reaching changes in policy and Fund activities.
Reviews and assesses internally produced monthly and quarterly status reports on the Group Insurance Fund; prepares quarterly analysis of revenues and expenditures, including current fiscal year revenue and expenditure projections; explains variances from approved appropriation and revenue levels; analyzes procedures and methodologies used to create these reports; develops and implements efficiencies to improve data reliability and/or streamline reporting.
Meets quarterly with the County's consultant for Group Insurance Fund programs to discuss overall health of the fund, actual versus forecasted experience, and other accounting issues (i.e., potential control exposures, timeliness of reports); reviews and assesses consultant generated performance and trend analyses reports; analyzes procedures and methodologies used to create these reports; and, based on these reports, determines and coordinates implementation of changes necessary to improve the fund's financial stability and procedural efficiency.
Provides subject-matter input, expertise, and advice to the Directors of OHR, OMB, and Finance regarding decisions setting annual contribution rates, major issues regarding the Group Insurance Fund, impact of changes, etc.; determines and presents to these managers the fiscal impact of any proposed policy or legislative changes that involve the Group Insurance Fund; as directed, prepares reports to CAO/Council on major issues regarding the Fund.
Prepares the Group Insurance Fund fiscal plan based on consultant's actuarial study of health plan and enrollment trend rates; prepares a current year projection of revenues and expenditures, an estimate of the next fiscal year appropriation and funding requirements; and a five-year fiscal projection; prepares alternative fiscal scenarios as needed for decision making.
Coordinates setting of calendar year fiscal year plan rates for budget development purposes with OMB.
Reviews and assesses Fund revenues and expenses as reflected in contract activities; works to improve communication and procedural efficiency in this area; coordinates and resolves issues that exist.
Performs related duties as required.
Self-Insurance Fund Manager:
Provides strategic support in the financial and statistical analysis of the County's Self Insurance Fund; provides oversight and management of the financial operations for the Fund including preparation and submission of the Fund's portion of the budget for the Self-Insurance program.
Manages the financial components of the claims operation; develops, implements, and conducts an audit process for annual claim payments to ensure adequately justified and accurate payments; collaborates with Claims Manager (contract administrator) within unit to improve process, including use of appropriate software, for transferring funds to appropriate third-party for claim payments; maintains detailed financial records of audit results; provides detailed statistical analysis of trends in self-insured claims including workers' compensation, automobile and general liability; provides monthly operational reports to superiors summarizing activity within the Self Insurance Fund and recommends process/accounting improvement to the program; benchmarks error rates and exception finding for notification to appropriate Finance Department officials.
Provides analyses including benchmarking with other self-insured public entities; evaluates trends in self-insured claims and recommends appropriate mitigation strategies.
Prepares data and supporting justification for the self-insurance portion of Finance Department budget plan submissions, including detailed summaries related to claims payments, contractual services, and charge backs to participating departments and agencies as they relate to the Self-Insurance Fund; coordinates with departmental managers and staff to resolve Self-Insurance Fund budget issues; provides regular reports and assistance to participating County agencies and departments on financial matters associated with risk management; develops statistical reports on budgetary matters related to the Self-Insurance Fund.
Administers contracted annual actuarial study; provides loss and underwriting data to the actuary; consults with actuary to develop strategies for eliminating large variations in projections from year-to-year; provides ongoing interface between the actuary and participating agencies and County departments; reviews actuarial study for accuracy and provides interpretation of results to appropriate County managers and participating agency representatives; provides periodic updates to the actuary during the year and manages other actuarial-related projects.
Performs related duties as assigned.
Experience: Thorough (5 years) applicable experience in the financial
or business administration field including one (1) year in either the
health care insurance or the self-insurance industry, depending on the
requirements of the position.
Education: Graduation from an accredited college or university with a Bachelor's Degree in Accounting, Business or Public Administration, or related field with a major in Accounting; or graduation from a recognized school of accounting.
Equivalency: An equivalent combination of education and experience may be substituted.
Knowledge, Skills and Abilities:
Thorough knowledge of accounting and financial management principles, practices, and procedures applied to managing a major insurance fund account.
Thorough knowledge of and skill in performing extensive and complex cost calculations and statistical analyses appropriate to monitoring cost and utilization of an insurance fund (i.e., health insurance fund or self-insurance fund).
Thorough knowledge and understanding of actuarial processes related to the subject area of assignment (i.e., health care or property/casualty); ability to review, analyze, interpret, and explain actuarial results from reports.
Thorough knowledge and understanding of property and casualty insurance company financial and claims operations including budgeting procedures and financial auditing of claims processes. (Applies to Self-Insurance Fund Manager only).
Thorough knowledge of and proficiency in the use of information technology tools applicable to the field of financial management, e.g., Microsoft Excel, Oracle, Crystal Reports.
Understanding of property and casualty insurance underwriting procedures (Applies to Self-Insurance Fund Manager only).
Understanding of the terminology and general business operations of either the health care insurance industry or the property and casualty insurance industry.
Comprehensive knowledge of federal, state, and county laws and regulations governing the administration of a health insurance or self insurance fund.
Skill in oral and written communication to exchange and/or present highly technical information to high level managers and administrators.
Ability to prepare and/or interpret financial reports, analyses, and statements and laws, regulations, policies, and procedures associated with health care insurance of self insurance.
Ability to develop and make improvements in accounting and transaction processing systems, procedures, forms, and records.
Interpersonal skills to establish and maintain effective working relationships with County staff, County managers at all levels, and contractual staff.
Ability to attend meetings or perform other assignments at locations outside the office.
Individuals appointed or promoted to this class will be required to serve a probationary period of twelve months, during which time performance will be carefully evaluated. Continuation in this class will be contingent upon successful completion of the probationary period.
MEDICAL PROTOCOL: Medical History Review
Class Established: September, 2004
Revised: September, 2005
Formerly Titled: Group Insurance Fund Manager