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).