Medical Underwriting Nurse
About The Position
Relying on limited experience and knowledge, this role is responsible for accomplishing the following assignments. These assignments are varied in nature. Key Responsibilities Review issues forwarded from the Underwriting group that includes complex diagnoses and then estimate ongoing costs. Provide this information to the specific Underwriter. Act as support for renewal underwriting. This includes, but is not limited to, assessing the severity code on on-going claims, adjusting reserves for accuracy, evaluating new referrals if effective within sixty days of notice, and assigning recommended specifics, if requested. Educate Underwriters on how to recognize specific diagnoses and severe types of diagnoses to ensure these are identified and properly quoted during the underwriting process.
Requirements
- 4 Year / Bachelors Degree in a related field or the equivalent education and/or experience
- Registered Nurse (RN) designation
- 5 Years Relevant and progressive clinical experience, preferably in an acute care or manage care/setting
- 5 Years Clinical experience, preferably in an acute care setting and/or managed care setting
- Strong medical knowledge including International Classification of Diseases (ICD), Current Procedural Terminology (CPT), medical terminology, COBRA, and HIPAA
- Strong understanding of operations of third-party administrators(TPAs) and managing general underwriters (MGUs)
- Knowledge of Carrier and Reinsurer reporting and contractual requirements
- Possess and have ability to apply broad knowledge of principles, practices, and procedures
- Excellent written and verbal communications skills with an emphasis on confidentiality, tact, and diplomacy
- Exceptional organizational and analytical skills; demonstrated ability to manage multiple tasks simultaneously
- Knowledgeable of industry changes, legal updates, and technical developments related to applicable area of the Company's business to proactively respond to changing business environment
- Intermediate proficiency and experience using Microsoft Office package (Excel, Access, PowerPoint, Word)
Nice To Haves
- Occasional travel (up to 10% of time)
Responsibilities
- Review issues forwarded from the Underwriting group that includes complex diagnoses and then estimate ongoing costs.
- Provide this information to the specific Underwriter.
- Act as support for renewal underwriting.
- Assess the severity code on on-going claims.
- Adjust reserves for accuracy.
- Evaluate new referrals if effective within sixty days of notice.
- Assign recommended specifics, if requested.
- Educate Underwriters on how to recognize specific diagnoses and severe types of diagnoses to ensure these are identified and properly quoted during the underwriting process.
Benefits
- Competitive salary and comprehensive benefit package
- Strong learning culture with ongoing development opportunities
- Opportunities for growth and career advancement
- Comprehensive medical, vision, and dental coverage, with eligibility beginning on your first day of employment
- Basic life and disability insurance
- 401(k) plan with 6% company match
- 20 days of PTO, two floating holidays, approximately 11 paid holidays, and volunteer time off
- Paid parental leave
- Access to our award-winning wellness program, including mental health services, fitness network membership, and a complimentary Headspace subscription
- Student loan matching program
- Employee discount program
- An opportunity to do meaningful work and love what you do
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
