Ensures the financial soundness of Individual business by analyzing an applicant's medical history to determine potential claims risk.
Maintains knowledge and understanding of our underwriting guidelines as well as state, federal regulations.
Knowledge of HIPAA compliance-ability to maintain confidential information.
In depth knowledge of our systems and the technical skill to navigate through them to get to information quickly.
Assist teams in other areas of my department when needed; this includes duties listed in my previous positions below.
Produced correspondence detailing plan eligibility/rates and provide customer service to internal and external customers.
Responsible for maintaining the underwriting letter library - updating and creating new letter templates.
Maintain reference manuals and procedure guidelines - assisted in updating user documentation of processes, policies, and procedures in response to business changes and ensure staff is updated on modifications.
Assisted in monitoring and distributing staff workload and training new employees -- sharing knowledge and encouraging others to help achieve specific team goals.
Handled difficult or escalated calls, appeals or inquiries from applicants, current members, member representatives and internal customers with a timely follow through.
Generating correspondence detailing plan eligibility/rates.
Checking in medical records as well as generating the requests.
Providing customer service by explaining the underwriting decision.
Reviewing correspondence for accuracy before sending to members and their agents.
Calling out to potential members in attempt to obtain additional health information when their application is incomplete.
Opt-Selecting (reviewing the file and data entered in system to confirm everything is correct--last step of underwriting).
Prepping files, data entry, sorting mail and miscellaneous.
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