Medical Underwriting Nurse
2 weeks ago
Tokio Marine HCC (TMHCC) brings 50 years of service to the specialty insurance industry, today offering over 100 products to commercial customers in 180 countries around the world. Organic growth and over 60 successful acquisitions have grown our 2022 Gross Written Premium (GWP) to $5 Billion. Our workforce has grown to 4,300 worldwide … big, but not so big that you cannot make a difference. Our Good Company values, including integrity, empowerment, and commitment to customer service, and a culture of innovation, communication, and collaboration make TMHCC a great place to work.
TMHCC Stop Loss, a $2 Billion division within TMHCC, leads the way in providing medical stop loss insurance sold to employers. Medical Stop Loss provides an added layer of insurance protection to employers who choose to self-fund their health benefit plans. Self-funding can incur risks from catastrophic claims, and Medical Stop Loss insurance from Tokio Marine HCC is designed to protect employers from that risk.
- This role is remote*
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
- 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.
- 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.
- 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)
- Generous paid time off (PTO), 12 paid company holidays,
- 401(k) Retirement Plan with 6% company match.
- Health and dental insurance, and vision plan available.
- Company-provided long-term disability and life insurance.
- Opportunities for advancement in a successful and growing organization.
- Flexible work schedules and a great work/life balance.
- Paid Parental Leave.
- Volunteer Time Off.
- Enjoy casual dress and work in a modern, comfortable office with free parking.
- Hybrid work schedule
#stoploss1
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