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

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

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