Underwriting AssistantTakeCare Asia Philippines, Inc.

Job Summary:
Reports directly to the Actuarial and Underwriting Team Lead and performs routine technical and analytical work under general supervision in support of underwriting analysis, decision making regarding pricing and risk selection, eligibility and enrollment using existing policies, procedures and guidelines. Responsible for researching and organizing data necessary for decision making on pricing and risk selection, monitoring timeliness of renewal of policies and performing other administrative tasks related to new and existing policies.
I. Essential Duties and Responsibilities:
1. Gathers and prepares preliminary analysis based on information from internal and external sources.
2. Researches functional issues using a variety of resources. Develops/prepares reports and assists in the development of new/revised policies.
3. Interprets government regulations and internal policies. Participates in preparation of documentation related to government filings/licensing.
4. Assists in the administration of assigned programs. Develops, maintains, audits and reviews functional databases and identifies inconsistencies.
5. Ascertains premium rates and cash revenues to ensure payment of future benefits.
6. Handles and implements the member and employer group fraud and abuse programs for the company.
7. Provides support in underwriting analysis for pricing and risk assessment selections and eligibility including financial, business, and trend analysis of data critical for decision making in achievement of business objectives.
8. Reviews and monitors Sales request submission for rating, fact sheets, contracts and claims reports and provides feedback on these requests to Sales.
9. Prepares ratings for new and existing commercial groups.
10. Prepares fact sheets and contracts for new and existing commercial groups.
11. Reviews and approves Individual plan application and generates contract for approved applicants.
12. Reviews, monitors and conducts underwriting assessment of Medicare Supplemental plans applications and prepares certificates for approved applicants.
13. Monitor and track renewal rating and fact sheet submission timeliness and process for existing commercial group.
14. Monitor and track Pricing and Underwriting department's work deliverables timelines and Service Level Agreements (SLAs).
15. Prepares and provides reports to identify non compliant groups to participation and underwriting requirements.
16. Provides assistance in product and business related initiatives and projects.
17. Prepares and provides reports to identify non compliance groups to required documentations such as business license, QWR, signed proposals and contracts.
18. Prepares and may do presentations. Participates in cross-functional teams to develop new/enhanced systems/processes/programs/policies to support business needs.
19. Assists in the product and business development initiatives of the company.
20. Performs other duties that may be assigned from time to time.
II. Experience & Specifications:
1. Bachelor's Degree in Nursing or any related field is preferred.
2. Health care related industry. At least 1 year Underwriting or any related experience is preferred.
3. Knowledge and Skills: Analytical, organizational and knowledge of basic life and health insurance underwriting. Knowledge of CPT, HCPCS, ICD and CDT coding is an advantage.
4. Effective team player. With very good interpersonal relationship skills and can work and relate well with co-employees, patients and customers.
5. Must have the behavioral sensitivity, maturity, diplomacy and tact in addressing complex situations and handling irate customers.
6. Outstanding oral and written communication skills.
7. Strong ethics and a high level of personal and professional integrity.
8. Must have basic familiarity on federal and state laws and requirements relating to insurance regulations.
Computer literate and very highly proficient in using MS office programs