Aetna Medical UW Cnslt in Hartford, Connecticut
Req ID: 39189BR
The position utilizes a process of data review, clinical assessment, medical status research and clinical experience, for the performance of disclosure review. The individual is also available as facilitator of options, resources and services to promote optimal, cost-effective outcomes, while meeting the individuals benefit plan. Position requires registered nurse with unrestricted active license.
East Coast Hours are preferred.
The Medical Underwriting Consultant utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individuals benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes. Clinical risk assessment is required for large claim disclosure. RN will perform clinical risk assessment by reviewing medical data, policy data and claim details. Identifies risk by applying consistent risk analysis standards, and then provides recommendations. The position utilizes a process of data review, clinical assessment, medical status research and clinical experience, for the performance of disclosure review. The individual is also available as facilitator of options, resources and services to promote optimal, cost-effective outcomes, while meeting the individuals benefit plan. Position requires registered nurse with unrestricted active license. The position is a registered nurse who operates at a mastery level. The individual may or may not have supervisory responsibilities. Desirable experience would include knowledge of or ability to learn usage of Aetna's claim reporting systems.
Must be a Registered Nurse, highly technical, analytical clinician with sound understanding of underwriting risk assumptions.
3+ years of related experience where medical underwriting is desired
3+ years of Healthcare, Individual and/or Group Insurance industry experience related to medical underwriting and risk assessment is desired
Background in high production environment.
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse (RN) is required
Nursing/Certified Case Manager is desired
Functional - Clinical / Medical/Disease management/1-3 Years
Functional - Nursing/Clinical claim review and coding/1-3 Years
Functional - Nursing/Case Management/1-3 Years
Full-Time Telework (WAH) will be considered.
ADDITIONAL JOB INFORMATION
This position will provide exposure to various market segments and all regions. The selected individual will work closely with the underwriters as well as the Shared Services Underwriting Team. The position is critical for determining risk on specific customers prior to the renewals being generated.
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.
Job Function: Underwriting