Clinical Medical Review - Oncology (Underwriting)

Clinical Medical Review – Oncology (Underwriting) (JR192475)

Hybrid 1: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law.

The Medical Underwriter Sr (Clinical Review) is responsible for determining acceptability of medically underwritten risks for more complex cases.

Primary duties may include, but are not limited to:

• Calculates appropriate group/individual premium rates for new business and renewal in accordance with Corporate Underwriting Guidelines and federal and state statutes.
• Proposes new business rates for complex cases ensuring rating compliance, utilizing a combination of medical applications, additional medical information, and manual rates.
• Calculates renewal rates for complex cases utilizing a thorough analysis of medical experience, location, demographic nature, etc.
• Evaluates medical information in order to assign appropriate underwriting decision.
• Monitors and review rating compliance reporting with actuaries for assigned business.
• Analyzes and responds to written and verbal underwriting inquiries.
• Participates in and may lead special underwriting projects.
• Interacts frequently with brokers and sales, administration and actuarial areas.

Minimum Requirements:

• Requires a BA/BS in a related field; Minimum 3 years of related experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

• RN license strongly preferred.
• 5 years of clinical experience in Oncology setting strongly preferred.
• Clinical documentation / medical chart review experience strongly preferred.
• Utilization Management experience preferred.

For candidates working in person or virtually in the below locations, the salary* range for this specific position is $79,200 to $129,600.

Locations: Illinois; Minnesota, New York, New Jersey

In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.