The Underwriter will generate new business rate proposals for medical, pharmacy, and stop-loss products while collaborating with cross-functional teams. They are responsible for analyzing group-level healthcare data, managing renewals, and ensuring pricing accuracy in alignment with regulatory requirements.
The Senior Manager oversees the end-to-end operations of the Appeals and Document Management teams, ensuring timely processing and accurate documentation. This role serves as an escalation point for complex determinations and coordinates workflows across internal departments and external partners.
The Implementation Specialist manages the onboarding and renewal process for employer groups, health plans, and vendors by coordinating timelines and system configurations. They serve as the primary liaison between internal teams and external partners to ensure accurate benefit plan setup and operational readiness.
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.
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.
