Individual Life & Disability UW III
Cambia Health Solutions

Job Info

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Medical Individual Life & Disability UW I, II or III, DOE
Open to anywhere in Washington, Oregon, Idaho and Utah


Primary Job Purpose

This position is responsible for medical risk analysis for individual and group business, the application misrepresentation process, grievance review, Insurance Commissioner inquiries and assistance in the preparation for litigation as necessary. They determine acceptable coverage levels for insurance applicants based on guidelines and submitted evidence as applicable. Also, communicates with Sales and Account Management as required on status of applications.

General Functions and Outcomes

• Accepts risks up to $750,000 per person for Life coverage, Long Term Disability coverage up to $10,000 per month per applicant with coverage duration up to SSNRA, Short Term Disability coverage up to $1,500 per week and Critical Illness coverage up to $50,000.
• Analyzes applicant's medical history to determine risk related to applied for levels of coverage.
• Performs a judgment of analysis of risk. This function includes research and compilation of medical data from several sources, including health applications, physician medical records and chart notes.
• Verify all vendor bills associated with the EOI underwriting process.
• Maintains a working knowledge of guidelines and/or mandates (state, federal, underwriting, enrollment, etc.) affecting processed lines of business.
• Maintains the EOI log providing essential tracking of all applications and reporting.
• Evaluates new enrollees for application misrepresentation.
• Reviews determinations with agents and/or applicants in writing or by phone as needed.
• Provides expertise and reports useful information to internal/external customers, identifies and resolves issues.
• Develops and maintains close relations with agents and internal personnel and ensures effective communication and understanding of the underwriting process.
• Participates in system enhancements, development, coordination, testing and implementation.
• Supports management reporting efforts and the development of automated rating and analysis tools.
• Assists with the updating and rewriting of the Underwriting and Desk Procedure Manuals.
• Assists in all aspects of application misrepresentation programs, including documentation of findings/decisions and communication of determinations to appropriate claims units.
• Investigates and solves problems involving proposal, enrollment, administrative, financial and contractual issues.
• Actively involved in the preparation and maintenance of underwriting guidelines and rating policy.

Minimum Requirements

• Knowledge of medical and pharmacological terminology and technical knowledge of medical diagnosis and procedures.
• Ability to understand and apply analytical concepts to determine medical risk and plan eligibility.
• Business sense including: finance, accounting, economics, and risk management principles.
• Experience with negotiation.
• General computer skills (including use of Microsoft Office, Outlook, internet search). Familiarity with health care documentation systems.
• Strong verbal, written and interpersonal communication and customer service skills.
• Ability to interpret policies and procedures and communicate complex topics effectively.
• Strong organizational and time management skills with the ability to manage workload independently.
• Advanced Medical Underwriting concepts and specific knowledge of medical impairments and the disease process.
• Voluntary life issues such as guarantee issue and analysis of potential adverse selection.
• Insurance code in all of the states LifeMap is licensed to do business in, plus the states with extraterritorial insurance laws.
• Maternity and selection issues for short term disability.
• Underwriting system competence and ability to assist in implementation of system and process changes that enhance productivity.

Normally to be proficient in the competencies listed above

The Individual Life & Disability UW III would have a Bachelor's degree in business, health or medical related field and 5 years of experience in individual underwriting or related experience in the medical field or equivalent combination of education and experience.

LifeMap employees are part of the larger Cambia Health Solution's family of companies, which seeks to drive innovative health solutions. We offer a competitive salary and a generous benefits package. We are an equal opportunity employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A drug screen and background check is required.

LifeMap is a life and disability insurance company, which offers additional benefits such as dental, vision, and short term medical coverage, to provide financial protection and access to care. People do business with us because of our high value products, our easy-to-understand language and our personalized service. We provide thoughtful guidance to help people choose the coverage they truly need through life's transitions.

Cambia Health Solutions is a nonprofit total health solutions company with community roots dating back to 1917. We advocate for transforming the health care system by making health care more affordable and accessible, increasing consumers' engagement in their health care decisions, and offering a diverse range of products and services that promote the health and wellbeing of our members. Cambia's portfolio of companies spans health care information technology and software development; retail health care; health insurance plans that carry the Blue Cross and Blue Shield brands; pharmacy benefit management; life, disability, dental, vision and other lines of protection; alternative solutions to health care access and free-standing health and wellness solutions.

Information about how Cambia Heath Solutions collects, uses, and discloses information is available in our Privacy Policy.

This position includes 401(k), healthcare, paid time off, paid holidays, and more. For more information, please visit www.cambiahealth.com/careers/total-rewards.

We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A drug screen and background check are required.

If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy.

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