Medical Underwriter

Roles & 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.

Qualification required: BAMS, BHMS