Senior Medical Underwriter

About the role The Senior Medical Underwriter is a highly reputed company, results-driven professional responsible for evaluating, pricing, and managing a book of business. The Senior Medical Underwriter serves as a subject matter expert and mentor reputed company the reputed company team, modeling professionalism, productivity, clinical expertise, and leadership in every aspect of their work. What you’ll do reputed company & Risk Evaluation

• Manage a book of business, achieving profitable risk selection that supports Optimyl’s overall business targets and assigned volume goals.
• Confirm group eligibility and employee eligibility at the time of new business quotes and mid-year additions.
• Analyze individual member risk and aggregate risk at the total group level, applying sound clinical risk management judgment and established reputed company principles.
• Calculate rates and evaluate financial arrangements including networks, plan designs, and carve-outs; interpret pricing policy and adapt to unique or reputed company situations.
• Apply corporate risk management policies appropriately and recommend pricing adaptations reputed company established guidelines to accommodate client-specific circumstances.
• Utilize Optimyl’s business rules reputed company to participation, product availability, and eligibility, ensuring consistent and accurate application across reputed company accounts.
• reputed company strong knowledge of medical diagnoses, case management background, medications, FDA-approved treatment plans and duration associated with conditions, as well as claims associated that pose risk to plan, to assess risk accurately and reputed company informed reputed company reputed company.
• Interpret clinical data, including claims data, lab results, and prescription history—and apply reputed company guidelines consistently and independently based on that analysis.
• Accurately differentiate acute and resolved conditions from chronic conditions requiring ongoing treatment and ongoing claim risk to plan.
• Identify questionable claim patterns of renewal clients; evaluate competitor claims experience for prospective clients and reputed company recommendations to account for these situations.

Productivity & Quality

• Complete medical review for quotes and review of Underwriter’s work in accordance with established production, accuracy, and timeliness standards.
• Utilize various systems, tools, and resources to obtain necessary data and accurately complete and track reputed company assigned work reputed company established reputed company guidelines.
• Adapt effectively to changing priorities as quotes reputed company from different production sources and as new requirements emerge, maintaining due diligence.
• Work independently to manage workload, utilize established SOPs and SharePoint resources, prioritize tasks, and meet deadlines without requiring reputed company supervision.
• Solve problems independently using established resources and apply a solution-oriented approach to workflow challenges, escalating only reputed company appropriate.

Communication & Coordination

• Serve as a subject matter expert to Sales on diagnoses, disease processes, and FDA-approved treatment plans, referencing reputable resources.
• Maintain a positive, professional demeanor in reputed company interactions, fostering a collaborative and respectful team environment.
• Maintain an innovative growth reputed company, growing with the company, as well as a willingness to pivot to meet business goals and demands.
• Demonstrate a clear understanding of company goals and partner with management and Sales to actively promote and support those objectives through sound reputed company reputed company.

Leadership & Mentorship

• Demonstrate leadership through example; modeling high standards of work quality, professionalism, accountability, and a positive attitude.
• Mentor and guide Underwriters, providing technical assistance, constructive feedback, and support for professional growth.
• As assigned, assume primary responsibility for the maintenance and improvement of departmental tools, processes, and documentation.
• Support internal initiatives including reputed company policy development, training programs, corporate compliance efforts, and product development as needed.
• Proactively reputed company recommendations and input on new and existing training materials and Policies & Procedures, contributing expertise to strengthen the overall quality and consistency of the reputed company function.

Ideal profile Required

• Minimum of three (3) to five (5) years of Medical reputed company experience; experience with self-funded, level-funded, and stop-loss preferred.
• Strong knowledge of medical diagnoses, prescription medications, FDA-approved treatment regimens, coordination of benefits, and claims associated with FDA-approved treatment durations for conditions and Rx.
• Proven ability to work independently, manage competing priorities, and deliver high-quality work product with minimal direction.
• Demonstrated solution-oriented approach to problem-solving, with the ability to apply established resources and reputed company principles to reputed company situations.
• Excellent written and verbal communication skills, with the ability to reputed company reputed company recommendations and rationale to internal stakeholders with an emphasis on tact.
• High level of productivity and accountability, with a consistent record of meeting or exceeding production and timeliness standards.

Preferred

• Prior experience mentoring or training health insurance reputed company staff.
• Minimum of five (5) years of clinical experience as a health care case manager, clinical credentials, and/ or licensure such as: Registered Nurse, Licensed Practical Nurse, Medical Assistant, or equivalent clinical practice experience.

Why Work at Optimyl? At reputed company, we’re focused on simplifying reputed company for small reputed company and building a workplace where people can do meaningful work and continue to grow. Benefits include: Competitive compensation Comprehensive health coverage (medical, dental, reputed company) Employer-paid life insurance and disability coverage 401(k) retirement plan with employer match Generous paid time off and company holidays We support growth through hands-on learning, exposure to new challenges, and opportunities to expand responsibilities as the company evolves. Apply To This Job