Livlong

Medical Risk Assessment & Underwriting Specialist Role Overview: This position is responsible for evaluating health insurance proposals and medical claims, assessing risk, and ensuring decisions are made in accordance with policy guidelines and regulatory compliance. The candidate should combine sound clinical judgment with strong underwriting acumen and innovative approaches to case evaluation. Key Responsibilities Review and process medical documentation and insurance claims to ensure accuracy, completeness, and compliance. Analyze patient information, laboratory findings, and treatment histories for risk assessment and decision-making. Determine coverage eligibility, exclusions, and appropriate premium modifications based on health risk profiles. Collaborate with healthcare providers, policyholders, and team members to resolve discrepancies and communicate outcomes. Guide acceptance or rejection of health proposals, applying robust risk evaluation techniques and recommending appropriate risk loading when necessary. Extract insights from Claims MIS and use data analytics to enhance underwriting decisions. Monitor regulatory changes and industry trends to continuously improve risk evaluation processes. Contribute innovative ideas for process optimization and risk mitigation. Required Skills & Competencies Strong foundation in medical science and clinical documentation. Expertise in health risk underwriting and claims assessment. Analytical mindset, detail orientation, and critical thinking skills. Ability to communicate clearly and collaborate with diverse stakeholders. Experience extracting and interpreting insights from claims data systems. Creative problem-solver, open to process innovation and improvement. Qualifications Bachelors or Master’s degree in life sciences, healthcare, insurance, or related field. Prior experience in health underwriting, medical risk assessment, or claims processing. Familiarity with healthcare regulations and compliance standards. This role requires individuals who can combine deep clinical insights and insurance expertise with creative, data-driven problem-solving to deliver fair, innovative risk assessments for health insurance proposals.