Job Description

The Underwriter is responsible for evaluating and underwriting stop-loss insurance. The role involves analyzing medical risk, pricing policies, and making recommendations based on a thorough understanding of both medical costs and insurance principles.

EDUCATION AND EXPERIENCE: A bachelor’s degree in business, finance, insurance, mathematics, or a related field. 2 -5 years of experience in insurance underwriting, preferably in the health insurance or medical stop-loss field. Experience with medical claims analysis, pricing, and risk management is essential.

SKILLS/COMPETENCIES REQUIREMENTS:

• Stay updated on industry trends, regulatory changes, and best practices in medical stop-loss underwriting.
• Risk management principles and stop-loss insurance products.
• Medical terminology, healthcare costs, and trends in medical claims.
• Regulatory and compliance issues in insurance underwriting.
• Strong analytical and problem-solving abilities.
• Proficiency in underwriting software (Connexure ESL Office).
• Excellent written and verbal communication skills for client interaction and report creation.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Evaluate submissions for medical stop-loss insurance of assigned captive program(s), assessing the risk posed by each potential policyholder.
• Analyze medical claims data and historical health costs to determine appropriate stop-loss coverage levels, including individual and aggregate limits.
• Review group health plans, claims experience, and member demographics to assess the potential for high-cost claims.
• Develop premium pricing for stop-loss insurance policies based on risk analysis and underwriting guidelines within delegate authority.
• Establish appropriate retention levels, deductible amounts, and policy terms based on the group’s needs and risk factors.
• Analyze claims data to assess trends, predict future claims, and identify risk patterns.
• Use various tools, including statistical analysis and software systems, to track claims history and predict future healthcare costs.
• Collaborate with clinical risk management team to assess potential for ongoing claims liability.
• Engage with internal and external stakeholders to explain policy terms, underwriting decisions, and negotiate terms when necessary.
• Support the sales team by providing underwriting insights and assisting with the proposal process for new business.
• Ensure all underwriting activities comply with regulatory requirements, industry standards, and company guidelines.
• Maintain accurate records of underwriting decisions, policies, claims history, and communication with clients.

TRAVEL: Occasional travel may be required for meetings, conferences, or client visits. This includes compliance with all of the requirements of the localities and destinations, as well as transportation carrier requirements.

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Applicants have rights under Federal Employment Laws: Family and Medical Leave Act (FMLA) Poster; Equal Employment Opportunity (EEO) Poster; and Employee Polygraph Protection Act (EPPA) Poster