Description
Review individual and group health insurance applications to evaluate medical risk, set pricing and coverage terms, and decide acceptance in line with company guidelines and regulations.
- • Decline applications that present excessive or uninsurable medical risk.
- • Request APS, medical records, labs, and clarifications from brokers, providers, or applicants; quote rates and explain underwriting policies.
- • Assess expected claim costs using morbidity tables, condition severity, prescription histories, and utilization patterns.
- • Apply rate-ups, exclusions, benefit limits, or waiting periods for substandard risks per guidelines.
- • Review internal records and prior claims to verify existing coverage, experience, and group demographics.
- • Recommend or authorize reinsurance or stop-loss for high-risk groups or large cases.
- • Analyze applications, health questionnaires, MIB and Rx data to determine eligibility and risk, and document decisions for compliance.
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Tasks & skills:
O*NET occupational data (work activities, skills, knowledge).
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This site includes information from O*NET by the U.S. Department of Labor, Employment and Training Administration (USDOL/ETA), used under the CC BY 4.0 license. Career Clutch has modified some of this information for student readability. USDOL/ETA has not approved, endorsed, or tested these modifications. O*NET® is a trademark of USDOL/ETA.
Last reviewed: Jan 2026
