Health Insurance Underwriter – A Day in the Life

Most of life’s decisions can be summed up as a calculation of risk versus reward. For most of us, the math in that equation doesn’t go much beyond a gut feeling. But for health insurance underwriters, it’s the basis of an entire career, and the implications of each calculation can be life-changing.

When a health insurance company issues an insurance plan to someone, they’re taking on some amount of risk. If the customer needs more medical services than they’ve paid in insurance premiums, the insurance company foots the bill. If a lot of customers start to follow that trend, then the insurance company has a huge problem—and it won’t be in business much longer. But if the insurance company denies a policy to too many customers, or charges too much in premiums, the wider market will provide cheaper, more equitable options—and, once again, the insurance company won’t be in business much longer.

That’s where health insurance underwriters come in and strike a crucial balance. Taking into account an applicant’s age, profession, pre-existing conditions, credit score, and a whole swathe of other data points, health insurance underwriters review insurance applications and determine eligibility, premiums, coverage, and exclusion policies. They’re the humans behind the math. And its complex math is made even more complicated by the ever-changing state of health insurance regulations.

For health insurance underwriters, the stakes are high. Approve too many people, and you sink a company that could’ve provided coverage to many more. Approve too few people, and you’re withholding care from someone who needs and deserves it. Striking the right balance isn’t about gut feel—though sometimes there’s a little of that involved, too—it’s about making careful and detailed calculations while maintaining some semblance of humanity and compassion.

Read on to get a glimpse at the daily life of a health insurance underwriter.

While a health insurance underwriter may need to travel for work or for a conference, they always call an office home base. Where that office is located can vary. One health insurance underwriter might work in-house at a large company to help them oversee employee benefit packages, while another health insurance underwriter might work at an insurance agency or brokerage.

A health insurance underwriter’s best friend is data, and their most relied upon colleague is their computer. But health insurance underwriters need to be smarter than any automated system and they’ll occasionally need to reach out to people—physicians, corporate executives, financial institutions, and peers—to arrive at a final decision. And, depending on an underwriter’s area of expertise (e.g., employee benefits insurance, self-funded insurance, etc.) further collaboration with clients and experts may be necessary.

Health insurance underwriters are the main link between insurance companies and insurance agents, and they spend their days reviewing insurance policies. Each policy is, by nature, unique. But it’s the underwriter’s job to look for parallels and clues that can inform the decision to deny, accept, or adjust a policy. While health insurance underwriters technically do the same thing on most days, it’s critical that they view each application with fresh eyes, and see the person behind the numbers. Each application is part puzzle and part formula.

Typical daily responsibilities for health insurance underwriters include:

• Analyzing an applicant’s information
• Calculating the levels of risk in a policy
• Evaluating algorithmic suggestions
• Coordinating with other experts for nuanced opinions
• Retrieving additional external data to aid in decision-making
• Determining the appropriate coverage and premium levels in a policy
• Reporting policy decisions to applicants

While the main goal of every health insurance underwriter is to reach decisions about individual policies, other soft skills are required as well. Staying up to date with corporate and federal regulations is a task in and of itself. And since so much of the work is done with the aid of computer software, it’s critical to maintain fluency with that software and all its updates.

Health insurance underwriters often don’t need much experience to get started, as employers will often provide on-the-job training which covers the specific tools and requirements of the position. Most health insurance underwriters have at least a bachelor’s degree, but a graduate-level education can make one’s resume rise to the top of the stack.

A master’s in healthcare administration can provide the precise skills necessary to become a first-class health insurance underwriter: shrewd financial sense, data-driven analytics, and objective decision-making. And options to specialize or concentrate can lead to industry-specific expertise in insurance operations, risk analysis, and regulatory compliance. Furthermore, graduate-level programs reinforce critical attributes of the job, such as detail-orientation and interpersonal skills; it’s one thing to be able to reach the correct conclusion, and another to be able to communicate it effectively.

The core skills of a health insurance underwriter are based in the solid and quantifiable pillars of math, logic, data, and analysis. But what makes a health insurance underwriter impossible to replace with any algorithm is their ability to combine those quantifiable pillars with qualitative ones, like compassion, context, and curiosity.

The National Association of Health Underwriters (NAHU) offers a wide range of specialized certifications that can enhance one’s career opportunities and distinguish health underwriters as experts in a niche market. While the old standard certifications of chartered healthcare consultant (CHC) and registered health underwriter (RHU) have been discontinued, NAHU has stepped in to provide a multitude of options for health insurance underwriters who wish to distinguish themselves.

NAHU certification course options include:

• The benefits account manager certification
• The benefits technology certification
• The consumer-directed healthcare certification
• The employer-sponsored plans in post-ACA era certification
• The HIPAA certification
• The individual health insurance certification
• The Medicare certification
• The self-funded certification
• The voluntary/worksite certification
• The wellness certification

While the requirements for each certification vary, the process generally involves taking an intensive course which consists of several webinar modules that are supplemented with quizzes and a final exam. Upon completion of all course material and final exam, graduates receive continuing education credits which, in many cases, can be transferred.

The cost and length of each certification, as well as the requirements for recertification, will vary based on the size and duration of the corresponding course. The benefits technology certification, for example, can be earned after completing just three hours of coursework and costs $179 for NAHU members and $279 for non-members. The employer-sponsored plans in the post-ACA era certification, on the other hand, consists of ten hours of coursework and costs $595 for NAHU members and $775 for non-members.

Beyond certification, NAHU membership has other quantifiable benefits. Members gain access to continuing education, advocacy groups, networking opportunities, compliance updates, industry news, media promotion, and professional recognition.