Medical Underwriter (Remote)

Resp & Qualifications

PURPOSE:
Responsible for the attainment, effective management, and profitability of a designated book of business.  This position utilizes underwriting judgment and exercises a level of authority.  Pricing concessions are permitted up to the designated level of authority without further review.  This position works closely with Sales and Account Management to ensure that client needs are met without compromising the corporate objectives.  This position is responsible for monitoring financial performance and apprising management as needed.

ESSENTIAL FUNCTIONS:

• To review stop loss claimants as well as fully insured claimants for new and renewing business, with limited oversight from more senior level MUW or manager, to support the financial underwriters' decisions. Medical underwriter assists in report completion, provides minimum number of articles and trainings to supplement financial underwriters' knowledge, while also providing technical expertise.

• Support attainment of corporate sales and profitability goals through the completion of claims reviews and the development of appropriate projected claims costs. Meeting the stated close ratio goals, average turnaround time goals. Providing clear documentation and file maintenance. Using the latest actuarial tables and factors.

• Responsible for observing changes in health care cost for conditions, including medical rx and advising more senior underwriters of same. Examine medical history, case management records and claims history, along with CareFirst book of business data.

• Provide support to Financial Underwriting, Sales and Account Management staff on shock claim related issues. Provide support to Finance, Legal, Operations, etc. as requested. Necessary support includes the following items: Communicating and negotiating directly with prospects, existing accounts, brokers & consultants. Participation in conference calls with prospects, existing accounts, brokers & consultants (with assistance from Management). Attending meetings with prospects, existing accounts, brokers, and consultants (with assistance from Management). Performing miscellaneous functions that support the department on as needed basis.

• Participate in formal and informal training activities to develop and enhance knowledge of underwriting methodologies, funding options, products, legislation, CareFirst competitors, and to ensure compliance with corporate and departmental policies. Necessary training includes the following items: Participation in internal and external courses. Providing Training Support, Mentoring and Coaching to Associate Underwriters. Becoming proficient in new underwriter tools and applications.

• Participate and have an active role in department special projects, while embracing change in a positive manner.

• Produces and monitors the issuance of Underwriting departmental reports for both internal management and external customers. Utilizes available data to isolate specific elements of account benefit plan performance and to support required rate actions as requested.

SUPERVISORY RESPONSIBILITY:
Position does not have direct reports but is expected to assist in guiding and mentoring less experienced staff. May lead a team of matrixed resources.

QUALIFICATIONS:

Education Level: Bachelor's Degree OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.

Experience: 3 years underwriting experience in group health, medical, ancillary benefits and/or pharmacy.

Preferred Qualifications:

• Experience in the health insurance industry, knowledge of medical and ancillary products, experience with fully and self-insured arrangements.
• ASN, BSN, MSN, or DNP preferred.

Knowledge, Skills and Abilities (KSAs)

• Individual must be knowledgeable of risk selection and pricing methodologies used within the health insurance industry.
• Individual must also have knowledge of industry laws and regulations, products, benefit plan designs, market trends and alternate funding arrangements.
• Good written and oral communication skills, preferably including the ability to explain complex topics to diverse and potentially hostile audiences.
• Strong PC skills and be proficient in Microsoft Suite of products.
   

Department

Department:Renewals

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer.  It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Hire Range Disclaimer

Actual salary will be based on relevant job experience and work history.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Federal Disc/Physical Demand

Note:  The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position.  Occasional walking or standing is required.  The hands are regularly used to write, type, key and handle or feel small controls and objects.  The associate must frequently talk and hear.  Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship.

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