Senior Medical Underwriter (Insurance)

TL;DR

Senior Medical Underwriter (Insurance): Analyzing medical risk factors for new enrollment, yearly renewals, and insurance contracts with an accent on risk management and clinical record review. Focus on determining benefit eligibility, assessing high-cost medical claimants, and preparing predictive cost reporting.

Location: Remote (Must be based in Pennsylvania, USA)

Company

hirify.global is a leading health insurance provider focused on risk management and affordable healthcare products.

What you will do

• Perform medical risk analysis for new and renewal individual and group insurance applications using medical review principles.
• Review medical and drug claims history to make enrollment and rating decisions.
• Prepare clinical record reviews and present medical underwriting appeals to physician advisors.
• Generate predictive reporting on high medical costs to determine renewal rates and potential future claims.
• Collaborate with legal, privacy, and compliance staff to resolve medical risk issues.
• Participate in quality improvement processes and bi-annual medical underwriting guideline reviews.

Requirements

• Must be based in Pennsylvania, USA.
• Current RN licensure in state(s) of practice.
• 5-10 years of relevant, progressive experience in medical underwriting.
• High School Diploma or GED.
• Proficiency in HIPAA, GINA, and PPACA regulations regarding protected health information.

Nice to have

• Bachelor’s Degree or 8-10 years of clinical/underwriting experience.
• Professional health claim coding or billing certification.
• 3+ years of direct clinical practice.

Culture & Benefits

• Remote work arrangement (Working at Home).
• Opportunity to teach and train others regularly.
• Structured annual development and productivity goals.
• Commitment to ethical business practices and legal compliance.