Medical Underwriting Nurse

Tokio Marine HCC (TMHCC) brings 50 years of service to the specialty insurance industry, today offering over 100 products to commercial customers in 180 countries around the world.  Organic growth and over 60 successful acquisitions have grown our 2022 Gross Written Premium (GWP) to $5 Billion.  Our workforce has grown to 4,300 worldwide … big, but not so big that you cannot make a difference.  Our Good Company values, including integrity, empowerment, and commitment to customer service, and a culture of innovation, communication, and collaboration make TMHCC a great place to work. 

TMHCC Stop Loss, a $2 Billion division within TMHCC, leads the way in providing medical stop loss insurance sold to employers. Medical Stop Loss provides an added layer of insurance protection to employers who choose to self-fund their health benefit plans. Self-funding can incur risks from catastrophic claims, and Medical Stop Loss insurance from Tokio Marine HCC is designed to protect employers from that risk. 

*This role is Remote, but must be available to work CST*

Position Summary:

Under general supervision, assess medical risk, predict and assign medical cost of care for claims and underwriting purposes

Key Responsibilities:

• Assess medical cost and clinical data utilizing multiple data sources and various software

• Provide risk assessment and cost projections for underwriting and claims based on medical condition, treatment plan and drug costs

• Stay up to date with the latest medical advancements and how they affect cost projections and recommendations

• Maintain strong medical knowledge, including International Classification of Diseases (ICD), Current Procedural Terminology (CPT), medical terminology, COBRA, and HIPAA

Education, Experience & Knowledge:

• 4 Year / Bachelor's Degree in a related field or the equivalent education and/or experience

• 5 Years of Relevant and progressive clinical experience

• Required Registered Nurse (RN) designation

• Strong understanding of third-party administrators (TPAs)

• Strong understanding of medical stop loss

• Strong case management background

• Ability to analyze multiple reports simultaneously with proficiency and experience using Microsoft Office package (Excel, PowerPoint, Word) and PDF

• Self-motivated and resourceful

• Work independently while collaborating in a team environment

• Exceptional organizational and analytical skills

• Excellent written and verbal communication skills with an emphasis on confidentiality, tact, and diplomacy

Tokio Marine offers a competitive salary and benefits package, including: 

• Generous paid time off (PTO), 12 paid company holidays,

• 401(k) Retirement Plan with 6% company match.

• Health and dental insurance, and vision plan available.

• Company-provided long-term disability and life insurance.

• Opportunities for advancement in a successful and growing organization.

• Flexible work schedules and a great work/life balance.

• Paid Parental Leave.

• Volunteer Time Off.

• Enjoy casual dress and work in a modern, comfortable office with free parking.

• Remote work schedule for this role

The reasonable pay range for this position is $ 69,500 to $140,500, subject to geographic adjustments, where applicable. The pay range is the range THMCC, in good faith, believes is the range of compensation for this role at the time of this posting. The hired applicant will be offered pay within the entire range based on qualifications, work experience, education, and/or skill level. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of color, race, sex, national origin, sexual orientation, religion, age, veteran status, disability, pregnancy, citizenship status, genetic information, or any other basis protected by federal, state, or local pay equity laws.

The Tokio Marine HCC Group of Companies offers a successful, dynamic organization experiencing rapid growth and are seeking energetic and confident individuals to join our team of professionals. The Tokio Marine HCC Group of Companies is an equal-opportunity employer. Please visit www.tmhcc.com for more information about our companies.

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