Medical Underwriter

3 weeks ago

Mumbai, India Career Shaper Full time

**Position Title **:Manager

**Department **:Underwriting-Medical Underwriting

**Level / Band**:401

**Role Summary**:

- Risk assessment and placement of profitable lives on the company books.
- Expertise on medical opinions, Higher test interpretation (ECG/TMT/stress ECHO etc.)
- Should be able to coordinate for Health product set up, benefits, guidelines, Riders etc.
- Ensure adherence to SLAs for CMO opined business (TAT & Accuracy).
- Ensure due diligence in medical evaluation to ensure mortality assumptions are on track.
- Mentor, guide & train In-House CMO
- Ensure quality & accuracy of CMO process
- Sharing feedback and conducting meetings with the relevant stakeholder’s time to time
- Evaluate emerging trends, competition practices, formulate options and propose recommendations on guideline to senior management

**B Organizational Relationships**

**Reports To **:AVP - Underwriting

**Supervises **:Manager
- Medical Underwriting (CMO and UW guidelines)

**C Job Dimensions**

**Geographic Area Covered**:PAN India

**Stakeholders Internal **:Claims, Actuaries, Product, Issuance, Zones, RCU

**External **:Vendor Partners ,Reinsurance

**D Key Result Areas**

**Organization Process**

**Key Contribution**

**To ensure quality & accuracy of Tele MER & Video MER processes and also ensure prudent risk management in UW**
- Good knowledge on insurance & products & ability to take decisions post issuance on medical as well as Financials with all product facts keeping in mind
- Ensure100% quality completion of medical opinion (CMO opinion and UW guidelines)
- Also ensure all the new business, Quality check, CMO opinion required on Underwriting of RCU findings post issuance, resolves, free look changes, reinstatements, group cases & claims re-underwriting cases received by the department as per the specified inter & intra department SLAs.
- Underwriting High value complex and HNI cases includes analyzing Profit and loss accounts with Balance sheet and other financial records
- Presenting case summary and representing to reinsurers, communicating with distribution stakeholders
- Coordination to Resolve requirement of CMO opinion for post issuance cases
- Preparing presentations and accuracy score to sr Management along with training of vendors

**To analyze key indicators every quarter and propose necessary amendments to achieve compliant and competitive risk assessment.**
- Templatising key factors that impact underwriting and in force business by type, product penetration and morbid conditions.
- Analyze the pending and closed business to facilitated identifying the trends with reason to offer solutions to minimize the same.
- Participate in the PIC to provide inputs on various aspects of risk management.
- To ensure periodic review of SOPs & SLAs to recommend amendments.

**To ensure and monitor professional & personal development of the staff.**
- Nominate the staff members for internal and external training programs basis their job responsibilities.
- To ensure performance optimization of the staff month on month to increase the productivity of the team.

**Risk**
- **‘Own-up’ the risk of the function by developing a risk aware culture through participation in measurement, analysis and mitigation of risks** associated with the respective function. This includes development of risk response processes, participation in contingency and business continuity programs and reporting of emerging risks with potential impacts. Also respond to risks highlighted by employees through formal / informal mechanisms and advice on various risk management issues within the organization and provide feedback. Participate in implementing risk mitigation plan through optimum resource allocation, monitoring and reporting on status.

**E Skills Required**

**Technical**
- Medical background
- Education - minimum MBBS /BHMS
- Experience - insurance experience, life + Health UW/claims 8-10yrs; knowledge on product set up, benefits, guidelines, Riders etc.
- Expertise on medical opinions, Higher test interpretation (ECG/TMT/stress ECHO etc)
- Able to conduct medical training for team, Partners
- Knowledge of evaluating various risk factors in Underwriting.
- Effective presentation and interpersonal skills.
- Good system skills in Excel/Word.
- Multitasking

**Essential: Desired**:
Analytical & Excel Skills Supervising/Leadership skills

Communication skills Influencing skills

Teamwork Skills

Relationship Building skills

Decision making skills

**Experience**:
8-10 years of relevant industry experience 6-8 yrs. of Domain Experience.

**Job Types**: Full-time, Regular / Permanent

**Salary**: ₹1,000,000.00 - ₹1,400,000.00 per year

**Benefits**:

- Health insurance
- Provident Fund

Schedule:

- Day shift

Supplemental pay types:

- Performance bonus
- Yearly bonus

Application Question(s):

- Do you have Medical background
- Education - minimum MBBS /BHMS?
- Do you have Experience - Insurance Experience, Life + Health UW/

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