Health Insurance Underwriter
A Health Insurance Underwriter evaluates and analyzes the risks involved in insuring people and assets for health insurance. They decide whether to provide insurance and under what terms.
Top Articles for Health Insurance Underwriter
Sample Job Descriptions for Health Insurance Underwriter
Below are the some sample job descriptions for the different experience levels, where you can find the summary of the role, required skills, qualifications, and responsibilities.
Junior (0-2 years of experience)
Summary of the Role
The Health Insurance Underwriter is responsible for evaluating and analyzing health insurance applications to determine the risk of insuring a potential member. The junior underwriter will work under supervision to assist in the assessment of applicants' medical histories, lifestyle factors, and other critical information to make informed decisions on coverage and premiums.
Required Skills
- Analytical thinking
- Detail-oriented
- Decision making
- Communication
- Time management
- Teamwork
- Knowledge of medical terminology and health insurance industry
- Proficiency in underwriting software
Qualifications
- Bachelor's degree in Business, Finance, Statistics, Healthcare Administration, or a related field.
- Familiarity with medical terminology and basic understanding of healthcare practices.
- Proficiency in using underwriting software and Microsoft Office Suite.
- Excellent analytical and decision-making skills.
- Strong attention to detail and ability to work accurately under tight deadlines.
- Effective communication skills and a team-oriented mindset.
Responsibilities
- Evaluate and process applications for health insurance coverage according to company policies.
- Analyze medical records, and risk factors to determine insurability and appropriate premium rates.
- Consult with medical professionals to clarify and obtain additional information regarding applicants' health.
- Assist in maintaining underwriting guidelines and ensuring compliance with state and federal regulations.
- Collaborate with other departments, such as claims and customer service, to ensure a seamless process for policy applicants.
- Stay up-to-date with developments in the health insurance industry and advancements in medical knowledge.
Intermediate (2-5 years of experience)
Summary of the Role
A Health Insurance Underwriter is responsible for evaluating and analyzing the risks involved in insuring people and assets. They establish pricing for accepted insurable risks and determine coverage terms. The role requires a good understanding of medical conditions, insurance policies, and risk assessment techniques.
Required Skills
- Analytical and decision-making skills.
- Strong mathematical and statistical analysis abilities.
- Excellent communication and negotiation skills.
- Detail-oriented with the ability to multitask and prioritize.
- Understanding of medical terminology and conditions.
Qualifications
- Bachelor's degree in finance, economics, health administration, or a related field.
- At least 2 years of experience in health insurance underwriting or a closely related field.
- Certification in health insurance underwriting or risk management is preferred.
- Proficiency in underwriting software and Microsoft Office Suite.
- Excellent knowledge of insurance law and health insurance policies.
Responsibilities
- Evaluate and assess the risks of insuring potential clients by analyzing medical history, occupational hazards, and financial background.
- Determine eligibility and develop coverage plans and premiums that match the risk levels while remaining competitive in the market.
- Maintain an up-to-date knowledge of industry changes, medical conditions, and advancements in health insurance underwriting procedures.
- Collaborate with actuaries, health care professionals, and insurance agents to gather and analyze data.
- Ensure compliance with company policies and regulations governing health insurance.
- Review and update existing policies to reflect any significant change in the risk profile or market conditions.
- Use underwriting software and actuarial data to assess risk and make informed decisions.
Senior (5+ years of experience)
Summary of the Role
A senior health insurance underwriter is responsible for evaluating applications for health insurance coverage, assessing risk, and determining policy terms and premiums. They work closely with agents, brokers, and clients, and utilize their extensive experience and knowledge in the field to guide their decisions.
Required Skills
- Excellent analytical and problem-solving skills.
- Strong communication and negotiation skills.
- Leadership and team management abilities.
- Ability to work with complex data and utilize statistical analysis.
- Attention to detail and precision in assessment.
- Proficient in underwriting software and Microsoft Office suite.
Qualifications
- Bachelor's degree in finance, economics, business administration, or a related field.
- Minimum of 5 years of experience as an underwriter in the health insurance industry.
- Professional certification in underwriting (such as the Chartered Property Casualty Underwriter (CPCU) designation).
- Strong understanding of medical terminology and health care systems.
- Knowledge of state and federal insurance regulations.
- Proven track record of accurate risk assessment and decision making.
Responsibilities
- Evaluate health insurance applications and determine the level of risk and coverage.
- Develop and maintain underwriting guidelines and risk assessment protocols.
- Collaborate with agents and brokers to provide expertise and guidance in policy selection and risk evaluation.
- Negotiate policy terms and premiums with potential clients.
- Analyze health trends and data to inform underwriting standards and practices.
- Manage a team of junior underwriters, providing training and support as needed.
- Stay up to date with regulations and compliance requirements in the health insurance industry.
- Perform detailed analysis of complex medical histories and documentation.
- Coordinate with other departments to ensure a seamless insurance application process.
- Address and resolve complex customer service issues involving underwriting decisions.
See other roles in Business, Consulting, and Legal Services and Insurance
Sample Interview Questions
