Job Description

RiskOne HR Consulting is seeking a

Group Medical Underwriter responsible for analyzing employee census data, claims experience, and underwriting factors to determine eligibility, set appropriate terms, and ensure sustainable profitability for both the clients and insurer partners.

Responsibilities:

Review group health insurance applications and employee census data. Analyze demographics, occupation types, industry risks, and group size. Evaluate past claims experience, utilization trends, and healthcare costs. Prepare monthly experience and utilization reports. Calculate premiums based on risk profile, claims experience, and actuarial assumptions. Structure benefit plans, contribution requirements, and rating adjustments for renewals and new groups. Recommend coverage terms, exclusions, or loadings as needed. Ensure competitive yet profitable pricing strategies. Coordinate and manage the RFP process across contracted insurers, ensuring accurate and timely submission of group data. Evaluate insurer quotes, underwriting assumptions, and proposed benefit structures. Negotiate terms, pricing, and plan design with carrier underwriters to secure the best options for clients. Compare proposals with multiple insurers and prepare client-facing reports to support decision-making. Work with agents, brokers, and HR teams to clarify census or claims data, explain underwriting decisions, and present options Maintain complete and accurate underwriting files with supporting rationale. Monitor group portfolio performance, loss ratios, and emerging healthcare cost trends.
Requirements:

Bachelor's degree in business, finance, healthcare, or related field (preferred). Minimum one year of experience in group medical underwriting and/or RFP management preferred, but entry-level candidates with the right skills will be considered. Professional designations or certifications in health insurance or underwriting (e.g., AHIP, LOMA) (preferred) Familiarity with healthcare regulations and compliance requirements. Experience using SQL to query health/claims data and Power BI to create dashboards and visual insights. Proficiency in underwriting tools, databases, and Microsoft Office. Bilingual (English | Spanish)
Equal Employment Opportunity Employer Minorities / Females/ Disable / Veterans.

Job Type: Full-time

Pay: $50,000.00 - $60,000.00 per year

Benefits:

401(k) Health insurance
Work Location: In person