The Clinical Review Nurse performs medical necessity reviews and manages utilization processes to ensure quality, cost-effective healthcare outcomes. They also collaborate with providers and support case management teams to coordinate care for members with complex health needs.
The Underwriter is responsible for generating new business rate proposals across medical, pharmacy, and stop-loss products while collaborating with cross-functional teams. They will analyze group-level healthcare data, evaluate risk, and ensure pricing accuracy for prospective and renewing clients.
The Client Service Specialist serves as the primary contact for employer groups and brokers, managing plan inquiries, eligibility, and claims processing. They also assist with onboarding, regulatory compliance, and cross-departmental collaboration to ensure data integrity and client satisfaction.
Develop rate proposals for medical, pharmacy, and stop-loss products while performing detailed claims and risk analysis. Collaborate cross-functionally with Sales, Clinical Services, and Finance to execute RFP responses and group renewals.
