Process Assocaites

Responsibilities: * Review lengthy or complex medical records (APS, lab reports, physician notes, hospital discharge summaries) and identify clinically significant findings relevant to underwriting risk. * Produce concise, standardized summaries highlighting diagnoses, chronic conditions, treatment timelines, medications, surgical history, and red-flag findings (e.g., cardiac, oncology, mental health, substance use). * Flag missing, unclear, or contradictory medical information that may require follow-up with the applicant, physician, or requester. * Apply consistent formatting/templates so underwriters can quickly locate key data points without reading full files. * Maintain strict confidentiality and compliance with HIPAA/data privacy and regional health-data regulations. * Collaborate with managers, leaders to clarify ambiguous cases. * Identify patterns or risk factors (e.g., recurring conditions, family history, lifestyle risks) that may affect premium calculation or policy terms. * Meet turnaround time (TAT) targets and quality benchmarks for each case reviewed. **Required Qualifications** =========================== * Bachelor's degree in Nursing, Life Sciences, Pharmacy, or a related medical/health field (preferred); insurance/underwriting background is a plus. * Strong understanding of medical terminology, disease processes, and common lab/diagnostic reports. * Familiarity with life/health insurance underwriting guidelines and risk classification is an advantage. **Key Skills** ============== * **Medical knowledge:** Ability to interpret clinical notes, lab values, imaging reports, and treatment histories. * **Analytical thinking:** Ability to separate underwriting-relevant details from non-essential clinical noise. * **Attention to detail:** Catching inconsistencies, missing data, or high-risk conditions that could impact policy decisions. * **Written communication:** Producing clear, concise, jargon-appropriate summaries for non-clinical underwriters. * **Time management:** Handling high case volumes while meeting strict TAT (turnaround time) commitments. * **Confidentiality & compliance awareness:** Strict adherence to data privacy standards (HIPAA or regional equivalent).