Medical Underwriting Manager

Help us insure it

Tokio Marine HCC is a global industry-leading specialty insurance group, backed by the strength and stability of the Tokio Marine Group. Offering over 100 classes of specialty insurance, we empower clients to pursue opportunities confidently through our “Mind Over Risk” philosophy. More than an insurance company, we are an organization built on innovation, unity, and trust.

At our core, we are Always Advancing, driven by innovation and an entrepreneurial spirit that keeps us moving forward. Our people are Experts in Tomorrow, using curiosity and smart working to anticipate what’s next. With a culture rooted in Reaching Out, we foster genuine collaboration and support, ensuring every individual has the opportunity to succeed and make a difference.

Role Overview

Manages the Medical Underwriting department of the Regional Office. Manages the review process of Request for Proposal (RFP) and renewal data for high-dollar and complex diagnoses and estimates remaining costs for underwriting recommendation and quoting. Ensures medical underwriting recommendations align with company guidelines, regulatory compliance, and service standards. Drives team development, enhances workflow efficiency, and collaborates closely with underwriting, claims, sales, actuarial, and other leadership teams to support business growth

Key Responsibilities

• Review issues forwarded from the Medical Underwriting Nurses and Underwriters that include complex diagnoses and require an estimate of ongoing costs.
• Oversee clinical assessments of medical records, questionnaires, and claims history to identify potential risks and recommend appropriate underwriting actions (such as exclusions, contract restrictions, etc.).
• Serve as subject matter expert for complex or escalated cases and reviews.
• Ensure thorough and timely documentation of medical underwriting decisions and rationale.
• Collaborate with Underwriting team to craft custom risk recommendations based on clinical insight and policy guidelines.
• Provide support for Underwriting team; this includes, but is not limited to, assessing the severity of on-going claims, adjusting reserves for accuracy, and evaluating new referrals.
• Act as a resource for the Sales and Marketing teams by providing clinical underwriting expertise and insights into risks, loss trends, and catastrophic claims.
• Represent the MUN team in internal meetings and cross-functional projects.
• Lead, coach, and develop a team of Medical Underwriting Nurses to maintain high performance and professional growth.
• Lead, coach, and develop a team of Medical Underwriting Nurses to maintain high performance and professional growth.
• Assign and prioritize workload based on case complexity, timelines, and business needs.
• Conduct regular performance reviews, provide mentorship, and establish individual and team development and professional goals.
• Educate Medical Underwriting Nurses and Underwriters on how to recognize specific diagnoses and severe types of diagnoses to ensure these are identified and properly quoted during the underwriting process.
• Develop, implement, and refine medical underwriting workflows, tools, and best practices to improve efficiency and quality.
• Analyze trends in underwriting decisions and recommend guidelines updates or training enhancements.
• Gather relevant information on an on-going basis to determine the plan's effectiveness and measure cost benefits and set accurate reserves.
• Educate the third-party administrators (TPAs) and vendors regarding the Medical Underwriting Program, as needed.
• Complete projects and other relevant duties as assigned by supervisor.
  
  

What You Bring

• 4 Year / Bachelors Degree in Nursing, a related field, or the equivalent education and/or experience
• Registered Nurse (RN) designation required
• 6 years of relevant and progressive clinical experience, preferably in stop-loss reinsurance, group health insurance, managed care, or related fields
• 3 years of leadership experience
• Strong medical knowledge including International Classification of Diseases (ICD), Current Procedural Terminology (CPT), medical terminology, COBRA, and HIPAA
• Strong understanding of operations of third-party administrators (TPAs) and managing general underwriters (MGUs)
• Knowledge of Carrier and Reinsurer reporting and contractual requirements Possess and have ability to apply broad knowledge of principles, practices, and procedures
• Deep clinical knowledge across multiple specialties, including chronic conditions, complex case management, and high-cost claims
• Excellent written and verbal communications skills with an emphasis on confidentiality, tact, and diplomacy
• Exceptional organizational skills with the ability to manage competing priorities and deadlines
• Ability to lead and inspire a team toward achieving department and organizational goals
• Knowledgeable of industry changes, legal updates, and technical developments related to applicable area of the Company's business to proactively respond to changing business environment
• Advanced proficiency and experience using Microsoft Office package (Excel, Access, PowerPoint, Word)
  
  

What We Offer

• Competitive salary and comprehensive benefit package
• Strong learning culture with ongoing development opportunities
• Opportunities for growth and career advancement
• Comprehensive medical, vision, and dental coverage, with eligibility beginning on your first day of employment
• Basic life and disability insurance
• 401(k) plan with 6% company match
• 20 days of PTO, two floating holidays, approximately 11 paid holidays, and volunteer time off
• Paid parental leave
• Access to our award-winning wellness program, including mental health services, fitness network membership, and a complimentary Headspace subscription
• Student loan matching program
• Employee discount program
• An opportunity to do meaningful work and love what you do
  
  

Pay Transparency

The pay range for this position is $126,000-$190,000, which includes geographic adjustments, where applicable. The pay range is the range THMCC, in good faith, believes is the range of compensation for this role at the time of this posting. The hired applicant will be offered pay within the entire range based on the candidate’s geographic location, qualifications, work experience, education, and/or skill level. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of color, race, sex, national origin, sexual orientation, religion, age, veteran status, disability, pregnancy, citizenship status, genetic information, or any other basis protected by federal, state, or local pay equity laws.

The Company will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, such as the Violent Crime Control and Law Enforcement Act of 1994 (18 USC

• 1033(e))(the “VCCLEA”), which restricts financial institutions and insurers such as TMHCC from employing individuals with certain types of criminal convictions. Where the hiring and employment of individuals is not restricted by the foregoing, the Company will consider qualified applicants with arrest or conviction history in compliance with applicable law such as the California Fair Chance Act, the Los Angeles Fair Chance Initiative for Hiring Ordinance, the Los Angeles County Fair Chance Ordinance, the San Diego Fair Chance Ordinance, and the San Francisco Fair Chance Ordinance.]
  
  

As an insurance company, we comply with certain federal, state and local laws such as the Violent Crime Control and Law Enforcement Act of 1994 (18 USC

• 1033(e)), which restricts our ability to employ individuals with certain types of criminal convictions. Where not restricted by law and for criminal history not covered by this law, the Company will consider qualified applicants with arrest or conviction history in compliance with applicable law.
  
  

You do not need to disclose your criminal history or participate in a background check until a conditional job offer is made to you. After making a conditional offer and running a background check, if the Company is concerned about a conviction that is directly related to the job, you will be given the chance to explain the circumstances surrounding the conviction or challenge the accuracy of the background report. The Company will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, such as the Violent Crime Control and Law Enforcement Act of 1994 (18 USC

• 1033(e))(the “VCCLEA”), which restricts financial institutions and insurers such as TMHCC from employing individuals with certain types of criminal convictions. Where the hiring and employment of individuals is not restricted by the foregoing, the Company will consider qualified applicants with arrest or conviction history in compliance with applicable law such as the California Fair Chance Act, the Los Angeles Fair Chance Initiative for Hiring Ordinance, the Los Angeles County Fair Chance Ordinance, the San Diego Fair Chance Ordinance, and the San Francisco Fair Chance Ordinance.]
  
  

Tokio Marine HCC is a leading specialty insurance group with offices in the United States,the United Kingdom, Europe, and other exciting locations. With the strength and stability that comes from being a member of the Tokio Marine Group, and more than fifty years of growth, profitability, and stability, we offer important insurance products that most people don’t even know exist. Every policy we write is special, enabling our clients to do amazing things.

Applying our Mind Over Risk philosophy to writing insurance allows our customers to take on opportunity with confidence. That philosophy defines our way of thinking, unites us as a team, and differentiates us from our competitors. We are much more than just an insurance company; we are a good company.

Equal Opportunity Employer

TMHCC is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to age, ancestry, citizenship, color, family or medical care leave, gender identity, genetic information, marital status, medical condition, national origin, physical or mental disability, protected veteran or military status, race, ethnicity, religion, sex (including pregnancy), sexual orientation, or any other characteristic protected by applicable local laws, regulations and ordinances.

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