Health Underwriter

Health Underwriting

Roles and Responsibilities :

• Processing Proposals in compliance with the SLA agreed and Guidelines Issued by Process Head/HOD
• Provide Underwriting decisions and terms of acceptance as per Guidelines issued by Process Head/HOD in new business referrals, portability referrals, pre-issuance queries, addition and deletion of members/benefits/coverage based on medical evaluation of proposal and documents submitted.
• Training of new team members
• Resolving Queries of Big Partners and Business channels
• Trouble shooting of Concerns of Sales Channels and maintaining a Professional conduct.
• Preparing Weekly and Monthly Roster for the Reporting Team Members
• Creating back up and contingency plan for Reporting team members on Holidays /Weekly offs in cases of Business Exigency
• Coordination with Vendors for PPMC and Tele /Video MER for Timely completion of Tests/Calling
• Non-disclosure / Re UW cases maintenance and publishing the reports to Process Head.
• Provide Underwriting decisions on post-policy disclosures and non-disclosures after evaluation basis medical merits in consultation with Process Head.
• To Follow up with the customer for past medical records and/or relevant health documents
• To Contact and follow up for the Exclusions, additional premium or altered conditions applied by the Underwriter, explain the reasons, explain the medical terminology in the laymans language.
• To Explain the denial reason (medical reasons) of the health application and to customer
• Attending and Resolving Grievances from Customers and Partners
• Assisting the Manager/Process Head for Building System Logics and Rule Engine
• Travelling to other cities for Attending Ombudsman Hearing and Other Public Forum Hearings
• Complying with the Guidelines framed by Process Head and HOD.
• Maintaining dignity and Good conduct with reporting team members for creating an Inclusive and Open Work culture
• Following and complying with Escalation Matrix.