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    Medical Underwriting Nurse

    Tokio Marine Hcc
    5+ years
    Not Disclosed
    Remote, USA
    10 Nov. 20, 2024
    Job Description
    Job Type: Full Time Remote Education: B.Sc./ M.Sc./ M.Pharm/ B.Pharm/ Life Sciences Skills: Causality Assessment, Clinical SAS Programming, Communication Skills, CPC Certified, GCP guidelines, ICD-10 CM Codes, CPT-Codes, HCPCS Codes, ICD-10 CM, CPT, HCPCS Coding, ICH guidelines, ICSR Case Processing, Interpersonal Skill, Labelling Assessment, MedDRA Coding, Medical Billing, Medical Coding, Medical Terminology, Narrative Writing, Research & Development, Technical Skill, Triage of ICSRs

    Job Title: Underwriting Support Specialist - Medical Stop Loss (Remote)

    About the Job

    Tokio Marine HCC (TMHCC), with over 50 years of service in the specialty insurance industry, offers more than 100 products globally. With a gross written premium (GWP) of $5 billion in 2022 and a workforce of 4,300 worldwide, TMHCC combines size with the opportunity to make a significant impact. The company’s values—integrity, empowerment, and a commitment to customer service—foster a culture of innovation, communication, and collaboration.

    TMHCC Stop Loss, a division generating $2 billion in revenue, provides medical stop loss insurance, protecting self-funded employers from catastrophic health claims. This role offers a fully remote work opportunity.

    Position Summary

    Under general supervision, the Underwriting Support Specialist reviews Request for Proposal (RFP) and renewal data related to high-dollar and complex diagnoses. The specialist estimates ongoing costs to assist with underwriting recommendations and quotes. The role involves educating underwriters on identifying severe diagnoses and ensuring accurate quoting during the underwriting process.

    Key Responsibilities

    • Review and assess complex diagnoses, estimating ongoing costs and providing this information to the underwriter.
    • Support renewal underwriting by evaluating severity codes on ongoing claims, adjusting reserves, and reviewing new referrals.
    • Educate underwriters on identifying specific diagnoses and severe conditions to ensure accurate underwriting and quoting.
    • Work closely with the underwriting team to ensure proper assessment of high-dollar medical conditions and risk management.

    Education, Experience & Knowledge

    • 5+ years of relevant clinical experience, preferably in acute care or managed care settings.
    • Strong understanding of ICD, CPT, medical terminology, COBRA, and HIPAA.
    • Knowledge of third-party administrators (TPAs), managing general underwriters (MGUs), and carrier/reinsurer reporting requirements.
    • Strong organizational and analytical skills with the ability to handle multiple tasks effectively.
    • Proficiency in Microsoft Office (Excel, Access, PowerPoint, Word).
    • Excellent verbal and written communication skills with a focus on confidentiality, tact, and diplomacy.

    Benefits

    • Competitive salary and benefits package.
    • Generous PTO, 12 paid holidays, and paid parental leave.
    • 401(k) retirement plan with 6% company match.
    • Health, dental, and vision insurance options.
    • Company-provided long-term disability and life insurance.
    • Opportunities for career advancement in a growing organization.
    • Hybrid work schedule and flexible work hours.
    • Casual dress and modern office with free parking.

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