Job List

Medical Underwriter 2

Requisition #2328394
Job LocationCanada-British Columbia-Burnaby
Job StreamAdministrative Support/Clerical
Job TypePermanent, Full-Time
Number of Positions Open1
Start Date of Employment ASAP
Posting Date08-Jul-2019
Travel RequiredNot Required
Educational RequirementsTechnical Certificate
Languages RequiredEnglish
Job Description

Under the general supervision of the Manager Disability Life Claims and Senior Medical Underwriter, reviews applications for all lines of Group and Individual coverage (EHC, Dental, Travel, Critical Illness, Optional Life and Long Term Disability) to assess eligibility and degree of risk and approves, postpones or declines coverage for complex applications requiring policy interpretation or involve new or unusual medical conditions. Initiates re-insurer reviews for complex applications and/or where carrier treaty dollar limits are specified. Troubleshoots client issues involving system variances or related application set up problems with broad system impact and initiates fixes where solutions require further research and analysis. Receives appeals from applicants following decline of coverage. Reviews and process applications from Pacific Blue Cross staff for all lines of benefits requiring medical underwriting. Contributes to the development of new and revised processes and tools by providing input and feedback on the content of procedures, manuals, templates and other materials. Provides informal work guidance and support to new Medical Underwriter 1s.

 

Job Duties

Medical Underwriting

  •  As a member of the Medical Underwriting team, reviews and processes applications for all lines of Group and Individual coverage (EHC, Dental, Travel, Critical Illness, Optional Life, Life Time Maximum, Disabled Dependents, and Long Term Disability) where applicant histories, conditions and coverage requirements are complex in nature by:
    1. analyzing applications for coverage including new applications, reinstatements of access to coverage and optional coverage to assess eligibility and degree of risk through review of a wide range of medical questionnaires, doctors’ reports, medicals, paramedical reports, ECGs, laboratory reports and pathology reports;
    2. identifying and evaluating factors affecting risk through the application of various in house and external systems and resources such as manuals, job aids, external databases and technical practice guidelines for complex cases;
    3. conducting in-depth research on individual medical conditions that are new and unusual, accessing new underwriting resources to determine past practice or experience with underwriting previously un-encountered risks and assessing options and alternatives for coverage; 
    4. requesting additional information from the individual as required through direct contact or written correspondence;
    5. reviewing contracts to identify benefits and contract limitations, interpreting policy guidelines and medical information where coverage or circumstances involve variables such as co-morbidities or multiple medical conditions involving one or more benefits;  
    6. assessing pre-existing conditions and their impact on approval or decline;
    7. identifying potential fraud or non-disclosure of information, conducting additional research to reconstruct application history and consulting with the Senior Medical Underwriter on appropriate action to take
    8. approving, postponing or declining coverage; consults with Senior Medical Underwriter in new and unusual circumstance and escalates where risks have major impacts;
    9. forwarding decision outcome information internally to Group Administration, Individual Plans, and Group Client Development and externally to Plan Administrators, Third Party Administrators or Brokers; forwards decline letters directly to applicants;
    10. responding to inquiries received directly from applicants and related parties on status of application or reasons for decline

 

  • Initiates re-insurer reviews for complex applications and/or where carrier treaty dollar limits are specified.
  • Troubleshoots client issues involving system variances or related application set up problems with broad system impact and initiates fixes where solutions require further research and analysis. Escalates issues affecting other PBC departments to the Senior Medical Underwriter for follow up.
  • Receives appeals from applicants following decline of coverage and conducts investigations and further analysis into applicant concerns to identify new information or revalidate the reason for the initial decline.
  • Reviews and process applications from Pacific Blue Cross staff for all lines of benefits requiring medical underwriting and approves, postpones or declines coverage.

 

General Team and Department Support

  • Contributes to the development of new and revised processes and tools by providing input and feedback on the content of procedures, manuals, templates and other materials to ensure compliance with current technical practices, professional standards and regulatory requirements.
  • On a one to one basis, provides informal work guidance and support to Medical Underwriter 1s by sharing knowledge and experience involving the technical aspects of medical underwriting and demonstrating the execution of specific tasks and activities on request.
  • Performs all other duties of the Medical Underwriter Level 1 including updating logs using the intermediate features of Excel, composing and producing letters using the intermediate features of Word, responding to general inquiries and providing administrative support to the department.
  • Maintains up to date knowledge of medical underwriting practices, policies and procedures, system requirements, PBC and BCLife product offerings and other information related to the provision of medical underwriting through continuous learning initiatives, in consultation with Senior Medical Underwriter. Participates in learning enrichment activities associated with medical underwriting for highly complex or high impact cases as opportunities arise.
  • Performs other assigned duties related to the provision of medical underwriting, administrative and clerical support which do not affect the rating of the job.

Qualifications:

  • High school graduation or equivalent
  • Successful completion of Academy of Life Underwriters (ALU) Level 2 Diploma (Associate, ALU) including completion of Medical Terminology 1 and 2 (to address self-study medical component of the ALU Level 2 Diploma) (360 hours)
  • Completion of Business Communications (writing skills) course (36 hours or equivalent)
  • Completion of Intermediate Word (18 hours)
  • Completion of Intermediate Excel (18 hours)
  • Typing skills of 40 wpm.
  • Demonstrated proficiency in the use of Intermediate Word and Excel, and Basic Math.
  • A minimum of three year previous related experience including at least one year as Medical Underwriter Level 1