Clinical Underwriting Specialist
1 week ago
MVP Health Care is committed to delivering high-quality healthcare solutions. We are seeking a skilled Clinical Underwriting Specialist to join our team. As a Clinical Underwriting Specialist, you will play a vital role in evaluating medical risks and making informed underwriting decisions.
About the Role
This position involves analyzing medical and pharmacy utilization reports to predict future claim costs. You will collaborate with healthcare providers and insurance teams to gather additional medical information as needed. Your expertise in medical terminology, conditions, treatments, and outcomes will be invaluable in making informed underwriting decisions.
Responsibilities
* Analyze medical and pharmacy utilization reports to assist underwriting in predicting future claim costs
* Collaborate with healthcare providers and insurance teams to gather additional medical information as needed
* Evaluate risks and opportunities in new business and renewal groups, and assess patient clinical needs against established guidelines
* Use knowledge of medical terminology, conditions, treatments, and outcomes to assist in making informed underwriting decisions
* Make recommendations based on analysis and review; providing clinical, medical review, and expertise for cost of care
* Work with the Care Management team to ensure claimants are engaged in care management protocols
What's in it for you?
* Competitive compensation package
* Comprehensive benefits focused on well-being
* Opportunities for growth and professional development
* A dynamic and collaborative work environment
Requirements
* Active Registered Nurse (RN) license
* Bachelor's degree in Nursing, Health Administration, or a related field preferred
* Minimum of 4 - 6+ years of professional relevant work experience, requires a minimum of two (2) years of clinical experience
* Knowledge of ICD 10 coding and medical terminology
* Strong understanding of medical conditions, treatments, and their long-term impact on health and insurability
* Ability to analyze complex medical information and make informed decisions
* Excellent communication and collaboration skills
Salary Information
The estimated salary range for this role is $69,383.00 - $83,000.00 per year, depending on location and experience.
Join Our Team
MVP Health Care is an equal opportunity employer and welcomes applicants from diverse backgrounds. We are committed to creating a healthy and inclusive work environment where everyone can thrive.
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