Responsible for review and analysis of underwriting data to expand and maintain a profitable book of business under direct supervision.
Manages agency relationships through continued customer service and supports marketing activities led by marketing manager.
Possess knowledge, critical analytical and strategic decision making skills to make independent underwriting decisions within letter of authority
Crum & Forster (C&F) provides specialty and standard commercial lines insurance products through our admitted and surplus lines insurance companies. They have more than 2000 employees and is increasingly winning recognition as a great place to work, earning several workplace and wellness awards.
Participate in provider case reviews to identify trends and deficits.
Coach providers and participate in client meetings to support expectations.
Contribute to workflow design, QA improvements, and risk management.
Amwell transforms healthcare with technology and people. They aim to provide convenient, affordable, and effective care, serving large healthcare organizations in the U.S. and worldwide.
Oversee a team of Claims Analysts and outsourced vendor staff.
Ensure team meets quality, production, and service expectations.
Address complex claims and customer service inquiries.
Jobgether is a platform that uses AI-powered matching process to ensure applications are reviewed quickly and fairly. They identify top-fitting candidates and share the shortlist with the hiring company, while not replacing human judgement in the final hiring decisions.
Complete timely review of healthcare services using appropriate medical criteria to support determinations.
Document clinical findings and rationale clearly and accurately in accordance with federal/state regulations, URAC standards, and Guidehealth policies.
Communicate precertification and concurrent review decisions—verbally and in writing—to required parties within defined timeframes.
Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Driven by empathy and powered by AI and predictive analytics, Guidehealth leverages remotely-embedded Healthguides™ and a centralized Managed Service Organization to build stronger connections with patients and providers.
Serve as the vendor’s lead clinical subject matter expert on clinical denials management and prevention.
Partner with provider clients to design and implement best practices for denial prevention and appeal workflows.
Conduct complex clinical case reviews for DRG validation, identifying and defending clinically appropriate DRG assignments.
EnableComp provides Specialty Revenue Cycle Management solutions for healthcare organizations. They leverage over 24 years of expertise and their E360 RCM ™ platform to improve financial sustainability for hospitals, health systems, and ambulatory surgery centers. EnableComp is a multi-year recipient of the Top Workplaces award recognized as Black Book's #1 Specialty Revenue Cycle Management Solution provider in 2024.
Enhance healthcare quality by overseeing performance improvement initiatives.
Ensure compliance with regulations and support data analysis.
Monitor quality metrics and drive projects to improve healthcare outcomes.
Jobgether is a platform that connects job seekers with potential employers, using AI to match candidates with roles. They focus on ensuring applications are reviewed fairly and efficiently.
Manage, process, and monitor Off Campus Authorization (OCA) requests through the online OCA system.
Coordinate with various departments and outside entities to produce or request required Certificates of Insurance.
Support initial investigation into risk management issues and identify and address customer needs related to potential and actual claims.
Oregon Health & Science University aims to provide a comprehensive risk management program contributing to health, safety, and protection of patients, employees, faculty, students, and visitors, while also protecting the University's resources. They manage over 30 lines of insurance and a captive insurance company, with claims managed internally.
Create and implement profitable professional lines insurance products.
Maintain and optimize the book of business through data analyses and scheduled audits.
Be accountable for reaching growth and profitability targets for the professional liability and medical malpractice portfolio.
Zensurance is a leading InsurTech company redefining commercial insurance for Canadian businesses, offering a digital-first experience. It values ownership, collaboration, and innovation, fostering a team that thrives on solving complex challenges and making a real impact.
Enroll and revalidate doctors and facilities with payors.
Process applications for licensing, permits, certifications, insurances, and relevant credentialing documents.
Review incoming insurance correspondence and mail and maintain and update credentialing spreadsheets accordingly.
CHOICE is the largest provider of pediatric dental care in the Southwest United States. They pride themselves on delivering high quality care to children in their communities.
Leads a team providing guidance on risk assessment methodologies.
Partner with tech-product-analytic teams to design and maintain sophisticated risk algorithms.
Develop a roadmap that defines the path to operationalize specific actions.
Aledade empowers independent primary care as the largest network in the country. They help practices, health centers, and clinics deliver better care to their patients and thrive in value-based care with a collaborative, inclusive, and remote-first culture.
Review daily inpatient and observation admissions to determine appropriate status.
Collaborate with physicians, case management, and insurance partners.
Utilize electronic medical records to support documentation, review, and reporting.
Logan Health aims to deliver quality, compassionate care for all, reimagining health care through connection, service and innovation. They value kindness, collaboration, trust, and strive for excellence in a supportive, mission-driven nursing culture.
Responsible for coordination of services for members, emphasizing education/self-management and quality care. \n- Assesses member needs, reviews service options, develops and implements care plans, and coordinates resources. \n- Manages a caseload of moderate-high risk members with complex medical/behavioral/psychosocial needs.
Capital Blue Cross is committed to improving the health and well-being of our members and the communities in which they live. They offer flexibility, prioritize health and well-being, and encourage employees to volunteer in their community.
Research and interpret payer policies in accordance with healthcare coding and regulatory requirements.
Identify common error areas that can be made into automated software logics that prevent overpayments.
Develop claims editing logics that promote payment accuracy and transparency across lines of business.
Rialtic is an enterprise software platform empowering health insurers and healthcare providers to run their most critical business functions. Founded in 2020 and backed by leading investors, they are tackling a $1 trillion problem to reduce costs, increase efficiency and improve quality of care.
Conduct complex risk assessments of insured properties.
Identify potential risk exposures and formulate strategic recommendations.
Analyze loss data and implement tailored loss prevention programs.
Summit Consulting, LLC. provides workers’ compensation programs and services to thousands of employers throughout the Southeast. They employ over 700 office and field associates and strive to provide an atmosphere of constant growth and development.
Manage an assigned underwriting territory to achieve profitable growth.
Identify new business opportunities and manage agency relationships.
Drive profitable growth across the state of Texas.
Berkley Aspire is passionate about making excess and surplus lines business easy to transact. We differentiate ourselves by continually innovating to bring market-leading technology and services to our agents and their clients.
Perform comprehensive review and oversight of medical records for Risk Adjustment compliance keeping with CMS and departmental guidelines with a 95%+ accuracy rate
Collaborates with a variety of internal and external clients, including health care executives, physicians, provider office personnel, and payer representatives from various health plans to streamline and optimize accurate diagnosis code capture.
Reviews medical records and billing history to determine if specific disease conditions were correctly billed and documented.
Capital Blue Cross promises to go the extra mile for their team and community. Employees consistently vote them one of the “Best Places to Work in PA” and they recognize that work is a part of life, not separate from it, and foster a flexible environment.
Conduct thorough assessments of patients' needs and develop treatment plans.
Monitor treatment effectiveness and adjust plans while documenting outcomes.
Advocate for patients to ensure quality care delivery and assist in cost reduction.
The company provides remote case management nursing services. The posting mentions an engaging company culture that values diversity and continuous learning.
Own and evolve the countrywide underwriting appetite for personal auto.
Lead regular reviews of underwriting rules and eligibility criteria.
Collaborate cross-functionally to clarify appetite and translate strategy.
Liberty Mutual's Personal Lines Auto Product team builds and rolls out auto insurance solutions. They are focused on auto, bringing deep expertise, data and analytics to deliver strong state-by-state results while modernizing how they price policies and the technology that supports them.
Promptly and accurately record all provider information.
Monitor status of payer applications to ensure completion.
Initiate and follow through on all aspects of provider credentialing.
UnityPoint Health is committed to team members and is recognized as a Top 150 Place to Work in Healthcare by Becker's Healthcare. They champion a culture of belonging where everyone feels valued and respected, and provide employees with support and development opportunities.