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Underwriter, Contracting & Network Development
Prisma HealthUnderwriter responsible for new and renewal medical stop loss business for Prisma Health. Evaluating and rating each risk to maximize premium revenue and ensure compliance with legal standards.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in medical underwriting, risk assessment, and compliance with industry regulations. Proficient in developing underwriting programs and financial modeling to optimize profitability and support health plan decisions.
Highest-signal resume keywords
Medical UnderwritingRisk AssessmentUnderwriting SoftwareFinancial ModelingActive Medical Underwriting Certification
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Risk EvaluationPremium Revenue MaximizationPricing AnalysisData CompilationLoss Ratio AnalysisInsurance PrinciplesRegulatory ComplianceAuditingForecastingPolicy Development
Soft Skills
Attention to DetailEffective CommunicationNegotiating SkillsTeam Collaboration
Tools & Technologies
Underwriting SoftwareA.I. ToolsActuarial Manuals
Certifications & Qualifications
Active Medical Underwriting Certification
Industry Keywords
Medical Stop LossGroup Health InsuranceSelf-Funded ProductsInsurance RegulationsHealth Plan Decisions
About the role
Key responsibilities & impact- Responsible for underwriting new and renewal medical stop loss business
- Reviewing, evaluating, selecting, and rating each risk to maximize premium revenue
- Responsible for the development, implementation, and maintenance of underwriting programs, policies, procedures, and guidelines
- Reviews Group health insurance applications and medical records to evaluate risk
- Uses underwriting software, A.I. tools and actuarial manuals to calculate rates, premiums, and factors
- Performs detailed pricing analysis and contribute to pricing strategies to optimize profitability
- Reviews stoploss offers and makes recommendations to the sales team
- Creates and updates financial models for forecasting and budgeting
- Conducts analyses to identify key metrics for modeling financial data
- Compiles data on yearly loss ratios and medical trends for program evaluation
- Communicates with stop-loss partners regarding risk levels and forecasted claims costs
- Consults with payer staff to obtain information, review insurance laws, and explain underwriting policies
- Collaborates with internal teams to understand monthly trends and ensure comprehensive risk evaluation
- Develops and maintains strong relationships with brokers, agents, and reinsurers
- Prepares detailed reports and documentation to support health plan decisions
- Maintains accurate records of underwriting decisions and related data
- Ensures compliance with legal standards and stays current on industry regulations and legislative changes
- Conducts regular audits of underwriting files to ensure quality and compliance
Requirements
What you’ll need- Bachelor’s degree in Business, Finance, or related field
- 7-10 years of related experience in Medical underwriting and risk assessment
- Active medical/health underwriting certification
- Knowledge of insurance principles, policies, and regulations
- Attention to detail
- Effective communication and negotiating skills, both written and verbal
- Ability to work collaboratively in a team environment
- Proficient in using underwriting software and tools
- Knowledge of underwriting self-funded and converting fully insured prospects into self-funded products
Benefits
Comp & perks- Health insurance
- Paid time off