Medical Underwriting Nurse
Under general supervision, reviews Request for Proposal (RFP) and renewal data for high-dollar and complex diagnoses and estimates remaining costs for underwriting recommendation and quoting.
Key Responsibilities Intro
Relying on limited experience and knowledge, this role is responsible for accomplishing the following assignments. These assignments are varied in nature.
- 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.
- Follow work plans, established timelines, and predefined goals for assigned work.
- Meet commitments on deadlines.
- Communicate activities, results, and observations with employees and management as appropriate.
- Identify areas for improvement in existing business practices.
- Perform work thoroughly in a cost-efficient manner and at a high productivity level.
Business Controls and Policies
- Comply with all corporate policies and procedures.
- Report any breakdowns in controls to management.
- Conduct all activities in a safe manner.
- 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)