Medical Underwriting Associate I

MEDICAL UNDERWRITING ASSOCIATE I

BASIC FUNCTION

The Medical Underwriting Associate – Level 1 supports the underwriting function by reviewing health plan applications and related documentation for individual products and performing key support activities that enable accurate and timely underwriting decisions. This role focuses on foundational underwriting review, medical record handling, and administrative underwriting processes.

REPORTS TO

Enrollment Team Supervisor

GENERAL RESPONSIBILITIES

The Medical Underwriting Associate I is responsible for the review of application, detailed medical records and claims, against Underwriting Department Guidelines. This person will:

· Review health plan applications and supporting documentation for completeness and eligibility determination

· Review Medical Reports for accuracy and relevance

· Perform Initial Underwriting Review and underwrite for traditional individual products

· Support underwriting operations through:

o Medical record processing and indexing

o Data quality review and validation

o Letter-related functions

o Short-term care processing

· Analyze medical documentation, including physician notes, lab results, and procedure reports, to extract relevant information

· Follow underwriting guidelines to support risk mitigation and accurate decisions

· Maintain established productivity and quality standards

· Communicate effectively with internal partners to ensure timely application processing

· Stay current on underwriting guidelines and process updates

· Provide superior internal and external customer service

· Support cross-training efforts and assist with additional tasks as assigned

· Consistently develop career path advancement goals

· Work overtime as required

· Perform other tasks as assigned

· Must consistently maintain the following accuracy rates during quality reviews

o Child apps – 90%

o Enhanced/Classic apps – 95%

o Individual apps – 85%

REQUIRED SKILLS

· Understanding of medical terminology

· Strong attention to detail

· Ability to multitask and manage multiple deadlines

· Critical thinking and sound judgment

· Adaptability and willingness to learn new processes

· Strong communication and teamwork skills

· Basic computer proficiency, including MS Word and Outlook

QUALIFICATIONS

Education: Associate’s degree or higher preferred

Work Experience: Healthcare background, education, or experience is preferred. Preference given to applicants with prior work experience in underwriting and extensive knowledge of insurance coverage.

Skills/Competencies: A successful candidate for the Underwriting Associate I position will possess the following skills and/or competencies:

· Critical Thinking – Ability to question, analyze, interpret, evaluate and make a judgement or decision with information presented. It is making reasoned decisions that are logical and well thought out.

· Accountability – Demonstrates a consistent level of performance; strives to maintain a steady level of productivity; meets deadlines in daily responsibilities and special projects without sacrificing quality of work. Ability to work independently and adapt quickly.

· Teamwork/Collaboration – Responds to others in a friendly and cooperative manner, especially in times of increased activity or short staffing situations

· Prudent Resource Use & Management – Contributes to efficiency through the wise use of both human and material resources. Strong organizational and time management skills

· Demonstrates the ability to establish productive, friendly and professional relationships with peers and others

Pay: $21.00 - $23.00 per hour

Benefits:

• Health insurance
• Retirement plan
• Vision insurance

Work Location: In person