高级专员，医疗核保（远程，任何州，美国）
Senior Associate, Medical Underwriter (Remote, any state, US)
职位描述：全职远程工作
业务部门概览
作为纽约人寿集团会员协会部门的一员，您将与全国最大的协会/亲缘计划人寿和残疾收入保险解决方案提供商合作。除了提供定制的人寿和残疾收入保险解决方案外，您的工作还促进了亲缘群体内的社区感和共同支持。
职位概述
向团队经理汇报，高级理赔评估员负责评估人寿保险申请，并决定申请是否应被批准、拒绝或需要更多信息。理赔评估员有权在其授权范围内批准或拒绝所有案件。
高级理赔评估员主要依靠理赔指南来评估申请人的风险分类；然而，由于多种状况或在主治医生声明中识别出的状况多样性所带来的复杂性，他们经常需要在没有明确指导的情况下评估申请人的风险。无论是综合医学实验室和家族病史的死亡风险，还是考虑高度相关因素（如机动车报告和业余爱好）的死亡风险，高级评估员应评估申请人的整体风险状况，而不仅仅是将各个风险因素相加。技术负责人、医疗总监和团队理赔员可在必要时提供咨询；但高级理赔评估员应提出决策建议，而不是开放式的寻求见解。由于该职位处理的大多数申请都包含主治医生声明，高级评估员必须具备医学术语的知识，并了解各种医学损害如何相互作用并影响个体的死亡率和发病率风险。也经常需要与第三方管理员人员互动。因此，高级理赔评估员必须具备良好的沟通和关系管理技能。他们还需要满足既定的生产标准和时效标准。
职责内容
- 能够高质量地完成大量工作
- 能够培训新的理赔员
- 评估人寿和残疾收入保险申请
- 审核争议性条款
查看英文原文
Location Designation: Fully Remote
Business Unit Overview
As part of New York Life’s Group Membership Association Division, you'll be working with the nation’s No. 1 provider of life and disability income insurance solutions for association/affinity programs. Beyond the tailored life and disability income insurance solutions you provide, your work fosters a sense of community and shared support within affinity groups.
Role Overview
Reporting to the Team Manager, the Medical Underwriter, Sr. Associate is responsible for evaluating life insurance applications and determining whether applications should be approved, declined or if additional information is required. The Medical Underwriter is authorized to issue or decline all cases within their authority limit.
The Medical Underwriter, Sr. Associate predominately relies on Underwriting Guidelines to evaluate an applicant's risk classification; however, due to the complexity associated with multiple conditions or the diversity of conditions identified within an Attending Physician Statement, they are frequently required to make assessments of applicant risk absent specific direction from the Underwriting Guidelines. Whether synthesizing the mortality risk of medical labs and family history or discounting the mortality risks of highly correlated factors such as motor vehicle reports and avocations, Senior Associates are expected to evaluate an applicant's overall risk profile, not simply summing the total from the individual risk factors. Technical leads, Medical Directors and Team Underwriters are available for consult as necessary; but the Medical Underwriter, Sr. Associates are expected to make a decision recommendation, not open-ended requests for insight. As the majority of applications reviewed by this role include Attending Physician Statements, a Sr. Associate must have a working knowledge of medical terminology and awareness of how various medical impairments interact and effect individual mortality and morbidity risk. Interaction with Third Party Administrator personnel is also often needed. Consequently, the Medical Underwriter, Sr. Associates must have strong communication and relationship management skills. They will also be required to meet established production standards and time service standards.
What You’ll Do
- Able to produce high volumes of work with quality results
- Ability to train new underwriters
- Underwrites Life and Disability Income applications
- Reviews contestable claims for misrepresentation
- Data Entry into Underwriting tracking system
- Reviews and evaluates non-standard applications and supporting documents
- Ability to differentiate multiple different requirements for numerous associations
- Determines if additional documentation is required and requests additional information as needed; decides if applicant is eligible for the plan
- Communicates with company employees and Third Party Administrators regarding underwriting procedures and insurance policies
Authority Limits
- Life up to $3M
- Disability Income up to $20K
What You’ll Bring
Qualifications
- Bachelor's degree preferred
- 3-5+ Years Medical Underwriting experience required
- Extensive knowledge of Medical Underwriting for Life Insurance. Disability knowledge is preferred; however, appropriate training will be provided in absence of that experience.
- Excellent verbal and written communication skills
- Data entry skills
- Ability to work in a paperless workflow environment
- Ability to prioritize and multitask
- Attention to detail and organizational skills
- Strong interpersonal skills
- Capable of working independently
Pay Transparency
Salary Range: $73,000-$100,000
Overtime eligible: Exempt
Discretionary bonus eligible: Yes
Sales bonus eligible: No
Actual base salary will be determined based on several factors but not limited to individual’s experience, skills, qualifications, and job location. Additionally, employees are eligible for an annual discretionary bonus. In addition to base salary, employees may also be eligible to participate in an incentive program.
Company Overview
At New York Life, our 180-year legacy of purpose and integrity fuels our future. As we evolve into a more technology-, data-, and AI-enabled organization, we remain grounded in the values that drive lasting impact.
Our diverse business portfolio creates opportunities to make a difference across industries and communities—inviting bold thinking, collaborative problem-solving, and purpose-driven innovation. Here, you’ll find the rare balance of long-standing stability and forward momentum, supported by an inclusive team that honors tradition while embracing progress.
As a Fortune 100 mutual company, we offer a place to grow your skills, contribute to meaningful work, and deliver solutions that matter. Your ideas drive what’s next, and your growth powers it.
Our Benefits
We provide a full package of benefits for employees – and have unique offerings for a modern workforce, including leave programs, adoption assistance, and student loan repayment programs. Based on feedback from our employees, we continue to refine and add benefits to our offering, so that you can flourish both inside and outside of work.Click hereto discover more about our comprehensive benefit options or visit our NYL Benefits Site.
Our Commitment to Inclusion
At New York Life, fostering an inclusive workplace is fundamental to who we are and how we serve our communities. We have a longstanding commitment to creating an environment where individuals can contribute their best and succeed together. This foundation is rooted in our core values of humanity and integrity, ensuring that every employee feels valued and supported. By embracing a broad range of perspectives and experiences, we achieve greater success and fulfill our promise of providing financial security and peace of mind to families across all communities. Click here to learn more about New York Life’s leadership in this space.
Recognized as one of Fortune’s World’s Most Admired Companies, New York Life is committed to improving local communities through a culture of employee giving and volunteerism, supported by the Foundation. We're proud that due to our mutuality, we operate in the best interests of our policy owners. To learn more about career opportunities at New York Life, please visit the Careerspage of .
Visit our LinkedIn to see how our employees and agents are leading the industry and impacting communities.
Visit our Newsroom to learn more about how our company is constantly evolving to meet our clients' and employees’ needs.
Job Requisition ID: 94827
Originally posted on Himalayas