Underwriting Officer at Mitera Health

Summary

• The Underwriter at Mitera Health HMO is responsible for assessing the risk associated with potential and existing members, determining appropriate premium rates, and establishing policy terms and conditions for health insurance plans.
• This role requires keen analytical skills, attention to detail, and a thorough understanding of health risk factors and regulatory requirements.

Key Responsibilities

• Evaluate individual and group health applications to assess risks and determine eligibility for health insurance coverage.
• Analyze medical histories, demographics, lifestyle factors, and other relevant data to quantify risk.
• Determine appropriate premium rates and policy terms based on risk assessment guidelines and actuarial data.
• Review Electronic Discharge Summaries (EDS) and other health records to inform underwriting decisions.
• Collaborate with sales, actuarial, and claims departments to ensure competitive pricing and sound risk management.
• Ensure all underwriting decisions comply with internal policies, industry regulations, and legal requirements.
• Prepare detailed reports of underwriting activities, including Utilization reports
• Assist in the development and refinement of underwriting guidelines and processes.
• Respond to inquiries from agents, brokers, and internal teams regarding underwriting decisions and guidelines.
• Monitor industry trends and regulatory changes impacting health insurance underwriting.

Qualifications

• Bachelor's degree in Actuarial Science, Statistics, Finance, Mathematics, or a related analytical field.
• Proven experience (3-5 years) as an Underwriter in the health insurance or HMO sector is essential.
• Strong analytical, critical thinking, and decision-making skills.
• Excellent understanding of medical terminology, health conditions, and their impact on risk.
• Proficiency in data analysis tools and software.
• Knowledge of health insurance laws, regulations, and industry best practices.
• Strong communication skills to articulate complex risk assessments and decisions.
• Ability to work accurately under pressure and meet deadlines