Underwriting Specialist

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.