Medical Underwriting Associate

BASIC FUNCTION

A Medical Underwriting Associate will review and assess individual, family or Medicare supplement health insurance applications submitted by potential and existing members to make health coverage determinations.

REPORTS TO: Enrollment Supervisor

GENERAL RESPONSIBILITIES

The Medical Underwriting Associate is responsible for the review of application, detailed medical records and claims, against Underwriting Department Guidelines. This person will:

• Review insurance applications and supporting documentation to determine eligibility and coverage
• Analyze applicant medical documentation including physician notes, lab results, and procedure reports to extract relevant information
• Mitigate company risk by carefully analyzing applicants’ information and make strong recommendations based on findings
• Identify insurance misrepresentations
• Assign premium amounts for each applicant, adhering to company policies and standards
• Work seamlessly with sales agents and other team members to ensure a smooth, speedy application process for potential members and maintain the established turnaround time
• Achieve productivity and quality guidelines set by underwriting leadership
• Keep abreast of changing underwriting guidelines
• Work with other departmental teams within the company and maintain good working relationships
• Identify problems or concerns and work toward solutions
• Be able to communicate effectively
• Provide superior customer service
• Consistently develop career path advancement goals
• Work overtime as required
• Perform other tasks as assigned

REQUIRED SKILLS

• Understanding of medical terminology to accurately interpret medical records
• Confident in decision making and the ability to explain processes or choices as needed
• Meticulous attention to detail
• Ability to multitask and work toward multiple deadlines simultaneously
• Flexibility to cross train
• Be able to adapt quickly and think critically

QUALIFICATIONS

Education: Bachelor’s or associate’s degree required. Medical coding certification preferred.

Work Experience: Healthcare background, education, or experience is preferred. Preference given to applicants with prior work experience in underwriting and extensive knowledge of insurance coverage.

Skills/Competencies: A successful candidate for the Underwriting Associate I position will possess the following skills and/or competencies:

• Critical Thinking – Ability to question, analyze, interpret, evaluate and make a judgement or decision with information presented. It is making reasoned decisions that are logical and well thoughtout.
• Accountability – Demonstrates a consistent level of performance; strives to maintain a steady level of productivity; meets deadlines in daily responsibilities and special projects without sacrificing quality of work. Ability to work independently and adapt quickly.
• Teamwork/Collaboration – Responds to others in a friendly and cooperative manner, especially in times of increased activity or short staffing situations
• Prudent Resource Use & Management – Contributes to efficiency through the wise use of both human and material resources. Strong organizational and time management skills
• Demonstrates the ability to establish productive, friendly and professional relationships with peers and others
• Skills in MS Word, Outlook; Basic computer knowledge and navigation