Medical Underwriter-Group(New)

Medical Underwriter

Position Summary:

The Medical Underwriter is responsible for evaluating and assessing medical risks associated with

individual and group health insurance applications. This role analyzes medical histories, clinical data, laboratory results, and underwriting information to determine eligibility, coverage terms, and appropriate premium rates. The ideal candidate combines strong analytical skills, medical knowledge, and regulatory

expertise to support sound underwriting decisions while balancing customer needs and organizational risk objectives.

Key Responsibilities:

• Review and assess medical applications, health questionnaires, laboratory results, physician statements, and other supporting documentation to determine insurability.
• Evaluate medical, occupational, and lifestyle risk factors and apply appropriate underwriting actions, exclusions, or premium adjustments.
• Apply established underwriting guidelines, rating methodologies, and regulatory requirements to new business, renewals, policy amendments, and reinstatements.
• Identify trends, inconsistencies, and potential risks within medical and underwriting data; document decisions with clear rationale and supporting evidence.
• Collaborate with Sales, Actuarial, Claims, Product, and Medical teams to ensure accurate risk evaluation, pricing, and policy issuance.
• Review and approve policy changes, riders, endorsements, and renewals based on updated risk assessments.
• Maintain current knowledge of insurance products, underwriting practices, medical advancements, and applicable regulatory requirements.
• Support the development, enhancement, and maintenance of underwriting guidelines, procedures, and best practices.
• Provide technical guidance, training, and mentorship to junior underwriters and underwriting support staff.
• Prepare and maintain audit-ready documentation and respond to inquiries from regulators, reinsurers, auditors, and internal stakeholders.
• Contribute to process improvement initiatives that enhance underwriting quality, efficiency, and consistency.

Required Qualifications

• Bachelor's degree in Insurance, Healthcare
• Administration, Life Sciences, Business Administration, or a related field; equivalent professional experience may be considered.
• 3–7 years of experience in medical underwriting, health insurance underwriting, or a related risk assessment role.
• Strong understanding of medical terminology, disease processes, diagnostic testing, and health insurance products.
• Proficiency in underwriting systems, risk assessment methodologies, and health data analysis.
• Demonstrated ability to interpret medical records, laboratory results, and clinical documentation.
• Excellent analytical, problem-solving, and decision-making skills.
• Strong written and verbal communication skills with the ability to explain underwriting decisions effectively.
• High level of accuracy, attention to detail, and organizational capability.

Preferred Qualifications:

• Experience underwriting complex individual and/or group health insurance products.
• Knowledge of behavioral health, chronic disease management, disability underwriting, or specialty risk assessment.
• Professional certifications such as CPCU, FALU, CPC, RMA, FLMI, or equivalent.
• Familiarity with applicable healthcare and insurance regulations, including ACA requirements and related compliance standards.
• Experience working with reinsurers and large-case underwriting.

Core Competencies

• Risk Assessment & Underwriting Judgment
• Analytical Thinking & Data Interpretation
• Regulatory Compliance & Governance
• Medical Knowledge & Clinical Evaluation
• Decision-Making & Problem Solving
• Collaboration & Stakeholder Management
• Effective Written & Verbal Communication
• Time Management & Organizational Excellence
• Attention to Detail & Quality Assurance
• Proficiency in Underwriting Platforms and Microsoft Office Applications

Education

& Certifications

• Bachelor's degree in a relevant discipline or equivalent combination of education and experience.
• Professional underwriting, insurance, actuarial, or healthcare-related certifications are highly desirable.