Responsibilities:
Review lengthy or complex medical records (APS, lab reports, physician notes, hospital discharge summaries) and identify clinically significant findings relevant to underwriting risk.
Produce concise, standardized summaries highlighting diagnoses, chronic conditions, treatment timelines, medications, surgical history, and red-flag findings (e.g., cardiac, oncology, mental health, substance use).
Flag missing, unclear, or contradictory medical information that may require follow-up with the applicant, physician, or requester.
Apply consistent formatting/templates so underwriters can quickly locate key data points without reading full files.
Maintain strict confidentiality and compliance with HIPAA/data privacy and regional health-data regulations.
Collaborate with managers, leaders to clarify ambiguous cases.
Identify patterns or risk factors (e.g., recurring conditions, family history, lifestyle risks) that may affect premium calculation or policy terms.
Meet turnaround time (TAT) targets and quality benchmarks for each case reviewed.
Requirements:
Bachelor's degree in Nursing, Life Sciences, Pharmacy, or a related medical/health field (preferred); insurance/underwriting background is a plus.
Strong understanding of medical terminology, disease processes, and common lab/diagnostic reports.
Familiarity with life/health insurance underwriting guidelines and risk classification is an advantage.
Medical knowledge: Ability to interpret clinical notes, lab values, imaging reports, and treatment histories.
Analytical thinking: Ability to separate underwriting-relevant details from non-essential clinical noise.
Attention to detail: Catching inconsistencies, missing data, or high-risk conditions that could impact policy decisions.
Written communication: Producing clear, concise, jargon-appropriate summaries for non-clinical underwriters.
Time management: Handling high case volumes while meeting strict TAT (turnaround time) commitments.
Confidentiality & compliance awareness: Strict adherence to data privacy standards (HIPAA or regional equivalent).
