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Medical Underwriting Nurse in Plano, TX at Tokio Marine HCC

Date Posted: 4/27/2018

Job Snapshot

Job Description

Position Summary:


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:


Relying on experience and judgment, the Medical Underwriting Nurse is responsible for accomplishing the following assignments. These assignments are broad in nature and work can be difficult.


  • 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.

Job Requirements


Position Knowledge, Skills, and Requirements:



  • Bachelor’s degree in or a related field or the equivalent education and/or experience
  • Registered Nurse (RN) designation required



  • Minimum of five years of relevant and progressive clinical experience, preferably in an acute care or manage care/setting
  • Minimum of five 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)


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