Clinical Underwriting Consultant

apartmentRMS Collect Phils., Inc. placeQuezon City calendar_month 

Job Description

Location: Open to all sites in the Philippines

Profile Summary:

Profile Description:

  • Serves as a subject matter expert in the evaluation of medical information to clarify

diagnoses, evaluate the severity of medical conditions, and estimate the duration of

treatment and expected future costs.
  • Researches clinical conditions and provides analytical review of the medical and/or
pharmacy data to formulate the history of events. Gathers and prepares preliminary clinical and medical analysis based on information from historical claims utilization data.
  • Provide support to rate development through timely and accurate clinical and medical

analysis to ascertain future risks and support the underwriting and risk management

Decision.
  • Works collaboratively with the cost containment team ensure a proper hand off of potential high cost patients. Prepares clinical and medical analysis based on employer group utilization and claims data and coordinates with the appropriate Cost Containment specialty teams to address these identified risks.

Knowledge & Experience:

  • Bachelor's degree - current unrestricted RN license, or equivalent clinical degree
  • Minimum 5 years of clinical experience
  • Minimum 2 years insurance experience
  • Analytical and problem solving skills
  • Excellent interpersonal and negotiation skills to act as a company representative
  • Experience in Microsoft Office products
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