Medical Underwriting Nurse

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*Position SummaryUnder 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 ResponsibilitiesReview 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.Education, Experience & Knowledge5 years Relevant and progressive clinical experience, preferably in an acute care or manage caresetting5 years Clinical experience, preferably in an acute care setting andor managed care settingStrong medical knowledge including International Classification of Diseases (ICD), Current Procedural Terminology (CPT), medical terminology, COBRA, and HIPAAStrong understanding of operations of third-party administrators(TPAs) and managing general underwriters (MGUs)Knowledge of Carrier and Reinsurer reporting and contractual requirementsPossess and have ability to apply broad knowledge of principles, practices, and proceduresExcellent written and verbal communications skills with an emphasis on confidentiality, tact, and diplomacyExceptional organizational and analytical skills; demonstrated ability to manage multiple tasks simultaneouslyKnowledgeable of industry changes, legal updates, and technical developments related to applicable area of the Company's business to proactively respond to changing business environmentIntermediate proficiency and experience using Microsoft Office package (Excel, Access, PowerPoint, Word)Tokio Marine offers a competitive salary and benefits package, including:Generous paid time off (PTO), 12 paid company holidays,401(k) Retirement Plan with 6% company match.Health and dental insurance, and vision plan pany-provided long-term disability and life insurance.Opportunities for advancement in a successful and growing organization.Flexible work schedules and a great worklife balance.Paid Parental Leave.Volunteer Time Off.Enjoy casual dress and work in a modern, comfortable office with free parking.Hybrid work scheduleThe Tokio Marine HCC Group of Companies offers a successful, dynamic organization experiencing rapid growth and are seeking energetic and confident individuals to join our team of professionals. The Tokio Marine HCC Group of Companies is an equal-opportunity employer. Please visit for more information about our companies.#stoploss1

Created: 2024-11-16