Medical Underwriter Group Medical

Job Summary

The Medical Underwriter (Group Medical) assesses and underwrites group health insurance applications, ensuring risk is accurately evaluated, pricing is appropriate, and products meet regulatory and company standards. This role collaborates with sales, actuarial, and operations teams to deliver competitive, sustainable solutions for employer groups while maintaining high levels of customer service and compliance.

Key Responsibilities

• Analyze medical and demographic information to assess risk and determine coverage terms, pricing, and eligibility.
• Underwrite group medical applications in accordance with company policies, pricing guidelines, and regulatory requirements.
• Collaborate with Sales and Analytics to evaluate client needs, propose appropriate plan designs, and provide risk-based recommendations.
• Review and validate medical underwriting notes, documentation, and endorsements for accuracy and completeness.
• Support new business, renewals, and re-pricing efforts, ensuring timely turnaround and quality of output.
• Identify and escalate unusual or high-risk cases, and participate in internal risk reviews and audits.
• Maintain up-to-date knowledge of medical trends, regulatory changes, and industry best practices.
• Provide guidance and mentorship to junior underwriters and cross-functional colleagues as needed.
  
  

• 2-4 years of experience in underwriting or health insurance, with a focus on group medical products.
• Bachelor’s degree in a related field (e.g., Finance, Actuarial Science, Health Administration, or Business).
• Strong knowledge of medical terminology, underwriting guidelines, and underwriting systems.
• Excellent analytical, problem-solving, and decision-making skills with attention to detail.
• Ability to manage competing priorities and deliver high-quality work in a fast-paced environment.
• Strong communication and collaboration skills to work effectively with internal teams and external clients.
• Proficiency with underwriting software, Microsoft Office, and data analysis tools.
• Regulatory acumen in health insurance (e.g., ACA, state-specific requirements) and compliance standards.
  
  

• 2-4 years of experience in group medical underwriting or related health insurance roles.
• Professional designations such as CPCU, ACA, FALU, or equivalent.
• Experience with pricing models, risk assessment, and plan design optimization.
• Familiarity with medical claim review processes and medical trend analysis.
• Leadership or mentorship experience within underwriting or claims teams.
  
  

• Strong analytical and numerical aptitude; proficient at risk assessment and data interpretation.
• Advanced problem-solving and critical-thinking capabilities.
• Effective written and verbal communication; clear and concise documentation.
• Collaborative mindset with the ability to influence and partner across functions.
• Customer-focused approach with a service-orientation for clients and internal stakeholders.
• High level of integrity, discretion, and adherence to confidentiality standards.
• Adaptability to evolving product lines, regulatory changes, and market conditions.
  
  

• Bachelor’s degree in a related field (as required in Required Qualifications).
• Relevant professional designations (e.g., CPCU, FALU) preferred.
• Ongoing continuing education to maintain knowledge of industry standards and regulatory changes.