బ్యాక్ ఆఫీస్ ఆపరేషన్స్

Job Description (JD) – Group Health Insurance Underwriter

Position Title

Group Health Insurance Underwriter

Department

Underwriting / Employee Benefits

Reports To

Underwriting Manager / Head of Underwriting

Job Summary

The Group Health Insurance Underwriter is responsible for evaluating and assessing risks associated with group health insurance policies. The role involves analyzing demographic, claims, and financial data to determine appropriate pricing, coverage terms, and underwriting decisions while ensuring profitability and compliance with regulatory and company guidelines.

Key Responsibilities

Underwriting & Risk Assessment

Evaluate new business submissions and renewal accounts for group health insurance plans.

Analyze census data, claims experience, utilization reports, and financial information to assess risk exposure.

Determine eligibility, coverage terms, limitations, and pricing recommendations.

Prepare underwriting quotations and renewal proposals in accordance with company guidelines.

Pricing & Profitability

Develop premium rate calculations and pricing models for group health products.

Monitor loss ratios and profitability of assigned accounts.

Recommend rate adjustments, benefit modifications, or risk management measures based on experience analysis.

Support product development and pricing initiatives through market and competitor analysis.

Broker & Client Support

Collaborate with brokers, agents, sales teams, and account managers to provide underwriting support.

Respond to underwriting inquiries and explain pricing or coverage decisions.

Participate in client meetings when required to discuss underwriting outcomes and renewal strategies.

Compliance & Reporting

Ensure underwriting decisions comply with applicable insurance regulations and company policies.

Maintain accurate underwriting records and documentation.

Prepare underwriting reports, portfolio analyses, and management summaries.

Support audits and regulatory reviews as needed.

Data Analysis

Review healthcare utilization trends, claims patterns, and emerging risks.

Identify opportunities to improve underwriting processes and portfolio performance.

Utilize underwriting systems and analytical tools to support decision-making.

Qualifications

Bachelor's degree in Finance, Mathematics, Statistics, Insurance, Business Administration, or a related field.

Professional insurance qualifications (e.g., LOMA, CPCU, or equivalent) are preferred.

Strong understanding of group health insurance products, underwriting principles, and healthcare claims analysis.

Experience

2–5 years of experience in health insurance underwriting, employee benefits underwriting, or a related insurance role.

Experience underwriting group medical, hospitalization, and employee benefit plans is preferred.

Required Skills

Risk assessment and underwriting expertise.

Strong analytical and quantitative skills.

Knowledge of health insurance regulations and market practices.

Advanced proficiency in Microsoft Excel and underwriting systems.

Excellent communication and stakeholder management skills.

Attention to detail and strong decision-making abilities.

Ability to manage multiple accounts and meet deadlines.

Key Performance Indicators (KPIs)

Underwriting turnaround time.

Portfolio profitability and loss ratio performance.

Accuracy of pricing and risk assessment.

Renewal retention rates.

Compliance with underwriting guidelines and regulatory requirements.

Quality and timeliness of underwriting reports.

Working Conditions

Office-based, remote, or hybrid work environment.

Occasional travel for client, broker, or internal meetings may be required.

Compensation

Competitive salary, performance incentives, and employee benefits as per company policy.

• It is a Full Time బ్యాక్ ఆఫీస్ / డేటా ఎంట్రీ job for candidates with 2 - 5 years of experience.