Medical Underwriting Review Nurse
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Medical Underwriting Review Nurse at NFP analyzing medical risks for self-funded employer groups. Reviewing claims and providing clinical guidance for underwriting and sales teams.
Responsibilities:
- Provide initial and updated individual medical risk analysis of self-funded and fully insured groups for proposed stop loss new business and renewals
- Review a variety of claim reports including shock loss/High-Cost Claimant, spec/50%, trigger, individual paid claim detail, pending, denied, prescription, precertification and case management notes as well as individual medical questionnaires
- Research medical conditions and treatment options using a variety of resources to predict potential future treatment plans, ongoing medical care and their probable costs by state and PPO
- Analyze the claims, costs, and clinical information to identify high risk individuals and assess financial costs for the upcoming plan years care for claimants who may exceed the stop loss specific and communicate this to Underwriting and Sales
- Document the medical review summary with specific analysis of the member’s clinical condition and annual claims projection with financial risk projection
- Provide clinical guidance to other team members as needed
- Review Restated Plan Documents for gap concerns and Amendments for stop Loss impact.
Requirements:
- RN designation required
- 5 years of clinical experience preferably in acute care setting
- Strong medical knowledge and Claims Experience w/ understanding of CPT (current procedural terminology)/ HCPCS and ICD10 codes (International Classification of Diseases), medical terminology, COBRA, HIPPA and Medicare
- Strong understanding of operations of third-party administrators (TPAs) and managing general underwriters (MGUs)
- Knowledge of Stop Loss, Carrier and Reinsurer reporting, plan language, and contractual requirements
- Excellent written and verbal communication skills with an emphasis on confidentiality, tact, diplomacy, and ability to work independently yet support team members with clinical and claims guidance
- Exceptional organizational, deductive reasoning and analytical skills along with ability to manage multiple tasks simultaneously.
Benefits:
- Competitive salary
- PTO & paid holidays
- 401(k) with match
- Exclusive discount programs
- Health & wellness programs
Similar Jobs
VP of Underwriting – Non-Agency
VP of Underwriting managing the Non-Agency underwriting department at CrossCountry Mortgage. Overseeing underwriting operations and ensuring compliance with service level agreements.
Director, Service & Underwriting Operations – P&C
Director managing underwriting and service operations for PEAK6, delivering outsourced insurance solutions across commercial and personal lines. Focus on underwriting excellence, profitability, and operational performance.
Underwriting Consultant, Wholesale Cyber/Media/E&O
Underwriting Consultant managing complex underwriting risks and pricing strategies at CNA. Developing relationships with agencies and overseeing underwriting training while ensuring compliance.
Risk & Underwriting Lead Analyst
Lead Analyst for Cigna Pharmacy executing Go‑to‑Market strategy and managing account‑level pricing. Collaborates with Sales on customer negotiations and strategic recommendations based on market trends.
Underwriting Assistant
Underwriting Assistant supporting the underwriting process for Mission Underwriting Services. Collaborating with underwriters and brokers to ensure accurate and timely policy processing.
Head of Underwriting – Mortgage Lending
Head of Underwriting leading non-QM mortgage operations focusing on credit policy and underwriting quality. Responsible for building and managing a high-performing underwriting team.
Risk & Underwriting Advisor
Responsible for executing Go-to-Market Pharmacy strategy at Cigna through pricing and customer negotiations. Analyze market trends to provide strategic recommendations and oversee account growth in pharmacy business.
Senior Underwriting Manager – Technology
Senior Underwriting Manager overseeing technology insurance products at Intact Insurance Specialty Solutions. Manage growth, profitability, and underwriting for a book of business in Maryland.
Mortgage Underwriting Trainer
Mortgage Underwriting Trainer at Neighbors Bank developing underwriting expertise and coaching a high-performing team. Responsibilities include training, mentorship, and underwriting support within a remote environment.
Underwriting Case Manager
Underwriting Case Manager at Crump responsible for evaluating insurance risks and managing complex cases. Working closely with agents and producers to determine competitive offer placements.
Director, Underwriting
Director of Underwriting driving disciplined pricing and risk evaluation within Prescryptive’s offerings. Leading complex deals and ensuring competitive pricing decisions.
Life Underwriting Specialist
Entry-level underwriter joining Northwestern Mutual team to assess and underwrite Life insurance policies. Focusing on quality risk assessment while collaborating with Financial Advisors and clients.
Underwriting Assistant – Workers Compensation
Underwriting Assistant supporting underwriters in evaluating and processing insurance policies at Amynta Group. Involves managing documentation, assessing risks, and developing management reports.
Technical Oversight – Underwriting
Technical Oversight leading underwriting management and workflows for Pylon's mortgage-as-a-service platform. Responsible for efficient loan origination and overseeing third-party fulfillment providers.
Associate, Corporate Development – Underwriting
Associate role evaluating acquisitions and managing financial models for ASC opportunities. Collaborating with senior leadership to make informed investment decisions.
Analyst – Mortgage Assistance Underwriting
Default Analyst working on mortgage assistance solutions for homeowners at Valon. Empowering homeowners through financial education and support during financial hardship.
Life and Critical Illness Underwriting Co-Signer
Underwriter Co-Signer at Manulife delivering high-quality underwriting services and mentoring junior staff. Managing applications worth up to $10 million while ensuring compliance with company policies.
Regional Underwriting Manager
Regional Underwriting Manager at Converge overseeing Cyber Liability underwriting and managing a strategic operational team for cyber risk solutions.
AVP Underwriting – E&O Media
AVP Underwriting position at Core Specialty focusing on Media and MPL E&O underwriting practices. Analyze submissions and advise on risk limits, pricing, and terms.
Underwriting Manager – Fleet
Underwriting Manager leading growth and high-impact fleet insurance at Nirvana. Developing and coaching underwriters while shaping organization strategy and decision-making in dynamic environments.