Senior Analyst - Medical Underwriting

Job Description Senior Analyst - Medical Underwriting Department: Medical Underwriting / Health Insurance Reporting To: Manager - Medical Underwriting / Head of Underwriting Job Purpose To perform comprehensive medical underwriting assessments for individual and group health insurance business by evaluating medical risks, analyzing complex clinical information, supporting pricing decisions, and ensuring adherence to underwriting guidelines. The role is responsible for maintaining profitability through sound risk selection, effective portfolio management, and collaboration with internal and external stakeholders. Key Responsibilities Medical Underwriting & Risk Assessment Evaluate individual and group medical insurance applications through detailed assessment of medical history, clinical records, diagnostic reports, and treatment plans. Analyze morbidity and mortality risks to determine appropriate underwriting decisions. Assess high-value and complex medical cases, including chronic illnesses, multi-morbidity profiles, and pre-existing conditions. Recommend acceptance, exclusions, loadings, postponements, or declinatures in accordance with underwriting guidelines. Conduct medical necessity evaluations and risk classification for various health insurance products. Pricing & Portfolio Management Support pricing teams by providing medical opinions, risk assessments, and cost projections. Contribute to portfolio profitability through effective risk selection and adverse selection mitigation. Review claims experience, utilization trends, and healthcare cost drivers to support underwriting decisions. Assist in developing underwriting strategies for corporate and group medical schemes. Underwriting Governance & Process Improvement Develop, review, and continuously enhance medical underwriting guidelines, manuals, and risk frameworks. Ensure compliance with internal underwriting policies, regulatory requirements, and reinsurance standards. Identify opportunities for automation, operational efficiency, and underwriting process improvement. Participate in underwriting system enhancements and digital transformation initiatives. Claims & Risk Management Support Collaborate with claims teams on complex medical claims and policy interpretation matters. Review high-cost claims trends and provide recommendations to control risk exposure. Assist in fraud detection, investigation reviews, and risk mitigation activities. Support claim adjudication through medical expertise when required. Stakeholder Management Provide technical underwriting guidance to brokers, sales teams, customer service teams, TPAs, and healthcare providers. Liaise with reinsurers regarding underwriting referrals and complex medical cases. Address underwriting queries and escalations from internal and external stakeholders. Deliver underwriting training and knowledge-sharing sessions. Data Analysis & Reporting Analyze underwriting data, claims trends, and portfolio performance metrics. Prepare underwriting reports, dashboards, and management presentations. Utilize analytical tools to support evidence-based underwriting decisions. Monitor underwriting quality and key risk indicators. Education Bachelor's Degree in Medicine, Health Sciences, Insurance, Nursing, Pharmacy, or related healthcare discipline. Professional insurance qualifications such as ALMI, LOMA, or equivalent are preferred. Experience Minimum 8-10 years of experience in medical underwriting, health insurance, reinsurance, or related healthcare insurance functions. Experience in individual and group medical underwriting. Strong exposure to medical risk assessment, claims analysis, and healthcare cost management. Knowledge & Technical Skills Medical underwriting principles and practices. Clinical case evaluation and interpretation of medical reports. Morbidity and mortality assessment. Health insurance products, policy wordings, and underwriting guidelines. Claims management and medical necessity assessment. ICD, CPT, DRG coding knowledge. Advanced Excel, Power BI, and reporting tools. Understanding of reinsurance and healthcare risk management practices. Competencies Analytical and critical thinking. Attention to detail. Risk assessment and decision-making. Problem-solving capability. Communication and stakeholder management. Team collaboration. Process improvement mindset. Customer and service orientation. Time management and prioritization.