Medical Underwriter-Temporary Worker

Medical Mutual; Providence (RI); On-site; USD 60,000 - 90,000; Full time

Job summary

Medical Mutual is hiring temporary Medical Underwriters to help during our busy season. The Medical Underwriter establishes appropriate new business and renewal premiums via evaluation of medical risk. Utilizes medical expertise to provide field support to broker distribution and internal customers to facilitate enrollment growth and profitability.

Reviews underwritten cases for quality assurance. Supports internal departments in project-oriented endeavors.

Qualifications

• Bachelor's Degree in health-related field or RN/LPN licensure with 1 year underwriting or health care experience.
• Level II requires a health-related degree or equivalent nursing licensure and 3 years underwriting experience.
• Senior requires a health-related degree and 5 years underwriting experience.

Responsibilities

• Evaluate medical conditions of prospective groups to determine risk tier.
• Support sales and internal departments to retain renewal business.
• Make rating recommendations based on profitability and utilization.
• Collaborate to establish underwriting criteria.
• Evaluate eligibility for changes and Medicare applications.
• Assist Compliance with medical records reviews for fraud/misrepresentation.
• Serve as SME on interdepartmental projects.
• Perform other duties as assigned.

Skills

Medical underwriting

Risk assessment

Healthcare terminology

Analytical thinking

Broker communication

Education

Bachelor's degree in health-related field

RN or LPN licensure

Ohio RN designation preferred

Job description

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.

Job Summary:

Medical Mutual is hiring temporary Medical Underwriters to help during our busy season. The Medical Underwriter establishes appropriate new business and renewal premiums via evaluation of medical risk. Utilizes medical expertise to provide field support to broker distribution and internal customers to facilitate enrollment growth and profitability. Reviews underwritten cases for quality assurance. Supports internal departments in project-oriented endeavors. Positions are onsite at our Brooklyn, OH headquarters Mon, Wed, Thurs and remote on Tue and Friday. Temporary assignment is late September thru mid January 2027.

Responsibilities:

• Evaluates and identifies underlying medical conditions of prospective groups to determine medical risk tier. Communicates medical condition/risk potential to the Group underwriter. Utilizes experience/expertise to proactively request additional information in an effort to reconsider/re-evaluate the rating of a prospective group.
• Supports sales and other internal departments to facilitate retention of renewal business. Reviews claims history/case management notes to determine future risk potential for member/dependent identified by group underwriter as a high claimant. Communicates medical conditions/risk potential to the Group Underwriter.
• Makes rating recommendations on prospective and renewal business based on profitability and utilization potential to meet corporate goals.
• Collaborates with internal departments to establish, review and change underwriting criteria.
• Evaluates medical risk/eligibility for individual change requests, short term, and Medicare supplement applications. Accepts/denies application or adjusts risk tier as appropriate.
• Supports Compliance department with review of medical records in determining potential fraud/misrepresentation.
• Serves as subject matter expert on interdepartmental projects.
• Performs other duties as assigned

Qualifications:

Education and Experience:

Level I

• Bachelor's Degree in health related field or Registered Nurse licensure and
• 1 year experience in Medical Underwriting or clinical health care.
• Or alternatively, Licensed Practical Nurse licensure and 3 years relevant experience.

Level II

• Bachelor's Degree in health-related field or equivalent combination of training (Licensed Practical Nurse or Registered Nurse) and experience.
• 3 years experience as a Medical Underwriter.

Level- Senior

• Bachelor's Degree in health related field or equivalent combination of training (Licensed Practical Nurse or Registered Nurse) and experience.
• 5 years experience as a Medical Underwriter.

Professional Certification(s):

• State of Ohio Registered Nurse designation preferred.

Technical Skills and Knowledge:

• Strong knowledge of medical terminology, medical conditions and associated health risks. Level I- Basic knowledge of medical terminology, medical conditions and associated health risks.
• Ability to apply medical expertise effectively in a health insurance business environment.
• Basic knowledge of individual and group underwriting policies and procedures and related regulatory compliance requirements/laws for prospective business.
• Senior Level- Knowledge of individual and group underwriting policies and related regulatory compliance requirements/laws for prospective business.
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