How Do I Become a Health Insurance Underwriter?

Health insurance underwriters help determine if those who have applied for a health insurance plan qualify for it. They review specific information such as the patient’s personal or family history with health issues and pre-existing conditions. They help quantify the risk to the insurance provider of taking on a particular patient and attempt to find ways to reduce future insurance claims from particular claimants.

These professionals help determine which perils and risks a health insurance company will cover and under what specific conditions clients will be covered. Employers have varying policies and regulations, in addition to state and federal regulations, which must all be considered for underwriting most effectively. Health insurance underwriters may also need to negotiate or clarify policies on behalf of patients when the situation concerns many claims, conflicting endorsements, restrictions of coverage, or treatments that are not generally considered standard.

Professionals in this role usually hold a bachelor’s degree in business administration, law, finance, economics, human resources, or another field. What matters most in gaining an entry-level position is one’s ability to demonstrate competency in analytics, composition, logic, regulations, calculation, document management, risk assessment, risk management, professional mediation, and even the occasional offering of advice.

Other professionals possess a marketable combination of a college degree, whether two- or four-year, and industry experience, either broadly or in the specific area of health insurance underwriting. Some in leadership positions even obtain master’s degrees in business (MBA) or health administration (MS, MHA). Both types of programs offer rich curricula in business and healthcare management. They typically range from one to three years.

In some positions, software applications automatically underwrite insurance applications through simple machine learning and adaptive assessments. However, the human touch is still a critical component of the insurance industry. Health insurance underwriters must keep tabs on industry standards, insurance law, medical developments, medical science, and any other area of medicine that’s relevant to their occupational concentration.

PayScale.com (2023), an aggregated source of self-reported salary data, reports that health insurance underwriters make an annual national average of $53,448, with possibilities for up to $7,000 in bonuses in specific higher-paying markets in major cities. The US Bureau of Labor Statistics (BLS) doesn’t distinguish health insurance underwriters from other types of insurance but reports a higher mean annual salary for insurance underwriters at $82,990 (BLS May 2022).

Health insurance underwriters can earn certification through various professional organizations:

• National Association of Benefits and Insurance Professionals (NABIP)
• The Institutes (American Institute for Chartered Property Casualty Underwriters) (AICPCU)

Certifications such as these will usually require the applicant to have the requisite number of years of experience (which varies) and any other educational requirements. Associations, organizations, and societies allow professionals to network with other people in the field and tap into a rich body of knowledge.

Like most administrative-type careers in healthcare, health insurance underwriters can work in an impressively wide array of medical, clinical, or office environments.

A day in the life of a health insurance underwriter entails showing up to an office or clinic and working in professional, highly technical environments where one is expected to field all the particulars of individual insurance claims. Health insurance underwriters often work for major insurance companies, on retainer for private organizations that manage many customer accounts, or in hospitals, specialist offices, and clinics where low-cost programs are available.

There are several ways to pursue a career as a health insurance underwriter. Below we’ll cover an example of how to begin to study, complete mastery of the subject, and transition into a rewarding career.

As a high school student, focusing on mathematics, statistics, science, and business will benefit any prospective health insurance underwriter. If available, take Advanced Placement (AP) courses in these subjects.

The general requirements to apply for a bachelor’s degree are:

• High school transcripts or GED
• A letter or statement of purpose or intent
• Completed application and fee
• SAT or ACT scores
• Any letter(s) of recommendation from an internship or work-study experience

Aside from the more general education requirements, gaining a bachelor’s degree in finance, business, business administration, economics, math, or statistics is a great place to start. Ideally, a degree program will have instruction in the following:

• Mathematics
• Economics
• Analytical sciences
• Individual health insurance
• Medical insurance
• Group benefits
• Life insurance
• Data science
• Statistics
• Business administration
• Computers
• Programming
• Medical expenses
• Contracts
• Long-term care
• Risk assessment
• Healthcare computer systems and electronic records
• Disability income
• Ethical and legal considerations of healthcare
• Foundations for healthcare vocabularies
• Rate making

Liberty University

Liberty University offers an online BSBA (bachelor of science in business administration) in healthcare management, providing students with the skills and knowledge needed for handling the administrative aspects of healthcare, such as financial operations, human resources, and marketing. Students in this online program will receive training that blends practical skills and knowledge through business, accounting, health services, and economics classes. Graduates will explore several ethical and legal issues that arise in health systems, such as data breaches, lawsuits, medical malpractice, labor and employment problems, patient confidentiality, and HIPAA compliance.

Made up of 120 credits, the program includes courses such as business analytics for decision-making; finance principles; human resource management; principles of macroeconomics; legal & ethical issues in healthcare; human resource management in healthcare administration; research & evidence-based practice; managing quality improvement in healthcare systems; and healthcare management & data analysis.

Graduates will learn about carrying out organizational communication, fiscal management, grant writing, and budget development for healthcare facilities. After completing this degree, they’ll know how to lead their organization with integrity and authority.

• Location: Lynchburg, VA
• Accreditation: Southern Association of Colleges and Schools Commission on Colleges (SACSCOC); Accreditation Council for Business Schools and Programs (ACBSP)
• Expected Time to Completion: 3.5 years
• Estimated Tuition: $390 per credit

Arizona State University

Arizona State University offers an online bachelor of arts program in business with a concentration in business administration. Students will learn about finances, forecasting demand, leadership, and more through this concentration. This program’s emphasis on general management skills means graduates can start their career in various industries, including working as a health insurance underwriter.

The business administration concentration will help students in developing and diversifying their business knowledge as well as teach them the skills they need for managing business operations. Comprising 120 credits, the program includes courses such as business operations and planning; leading organizations; principles of management and leadership; global supply operations; marketing and business performance; fundamentals of finance; and business law and ethics for managers.

Along with gaining a solid grasp of team leadership, finances, and risk, graduates of this program can take the lead in key business opportunities such as conducting skillful negotiations, building strategies for the future, planning inventory, forecasting demand, and purchasing services.

• Location: Tempe, AZ
• Accreditation: Higher Learning Commission (HLC); Association to Advance Collegiate Schools of Business (AACSB International)
• Expected Time to Completion: Two years
• Estimated Tuition: $714 per credit

It should be noted that not all health insurance underwriters are required to have an undergraduate degree. A few years of industry experience could go a long way to making oneself a desirable candidate for employment as per employer discretion.

While most entry-level health insurance underwriting positions do not require special training or certification, applicants generally need an associate’s or bachelor’s degree. Gaining industry experience helps these professionals prepare for certification and more advanced positions. Depending on the type of certificate sought, the expertise required could be anywhere from one to five years.

Regarding advocacy, training, and development, the National Association of Benefits and Insurance Professionals (NABIP) leads the market of professional health insurance societies. There are many more general authorities on insurance underwriting, such as the American Institute for Chartered Property Casualty Underwriters (AICPCU). Another excellent resource is the American College of Financial Services, which currently offers the chartered life underwriter (CLU) credential.

NABIP offers other insurance underwriter certifications for the Affordable Care Act and patient protection, a benefits account manager certification, and advanced self-funding certification. The organization also hosts a database of professional development and upskilling resources, such as online module courses in HIPAA regulations, the fundamentals of health insurance, Medicare, principles and ethics, employer-sponsored plans, and benefits technologies.

In addition to these resources, NABIP operates an ever-updating record of federal statutes concerning health insurance and a long-term care portal, which brings professionals together to collaborate on the best practices for selling, improving, and providing long-term care products to patients.

Please note that state licensing varies. Check with local agencies for detailed information on licensing and continuing education requirements. For example, the California Department of Insurance requires insurance agents and brokers to meet specific requirements: be at least 18 years of age, have 20 hours of approved pre-licensing study, and 12 hours of approved pre-licensing study on code and ethics.

Enrolling in a master’s program in insurance underwriting can allow these professionals to delve even deeper into the field and gain valuable industry knowledge. Pursuing a master’s degree in finance focusing on insurance underwriting can open the door to the top—the highest-achieving level of insurance underwriting. Students in these programs take courses in:

• Individual health insurance
• Medical insurance
• Group benefits
• Life insurance
• Business administration
• Computers
• Medical expenses
• Long-term care
• Risk assessment
• Healthcare computer systems
• Legal considerations of healthcare
• Rate making

Maryville University

Maryville University offers an online master of health administration program that can be completed entirely online. Students in this program can either complete the general program or choose one from the four available concentration options in health informatics and analytics; healthcare leadership; population health management; and senior services.

Applicants to the program must have a bachelor’s degree from a regionally accredited institution with a cumulative GPA of 3.0, an understanding of basic statistics, a personal letter explaining qualifications for graduate work, and TOEFL scores for international students. GRE or GMAT scores and letters of recommendation are not required for admission.

Consisting of 33 to 36 credits, the program includes courses such as healthcare industry and its impact on healthcare management; healthcare operations; healthcare human resources and organizational behavior; healthcare quality and performance improvement; healthcare financial management; healthcare marketing; healthcare informatics; introduction to gerontology; and managerial epidemiology.

• Location: St. Louis, MO
• Accreditation: Higher Learning Commission (HLC)
• Expected Time to Completion: Two years
• Estimated Tuition: $749 per credit

Indiana University

Indiana University offers an online master of science degree in finance exposing students to coursework in quantitative analysis, financial management, economics, value creation, capital markets, and risk management. Graduates will be ready for positions such as insurance underwriters, financial analysts, auditors, commercial bankers, budget analysts, financial planners, and portfolio managers.

Admission requirements to the program include a bachelor’s degree, a completed application, GMAT or GRE scores, official transcripts, and TOEFL test scores for international students.

This 30-credit program includes courses such as managing accounting information for decision-making; economics for managers; financial management; asset pricing & security valuation; valuation & capital investment; international financial management; financial analysis and firm valuation; and fixed income and equity asset valuation.

Graduates will learn to view finance as an integral business function, efficiently use financial resources, evaluate opportunities to create value in an organization, learn about the financial instruments used by organizations for managing risk and uncertainty, and appreciate how capital markets value financial securities.

• Location: Bloomington, IN
• Accreditation: Higher Learning Commission (HLC)
• Expected Time to Completion: Two years
• Estimated Tuition: $1905.12 per credit

Case Western Reserve University

The online MBA focused on healthcare offered by the Weatherhead School of Management at Case Western Reserve University is ideal for working healthcare professionals who wish to develop evidence-based business management skills and become leaders in this industry. Blending live class sessions and self-paced modules with two in-person residencies, the program helps graduates develop the business skills and knowledge needed to improve the patient experience and organizational efficiency. Graduates will learn how to create new systems, minimize operational disruptions, and optimize processes.

The program comprises 48 credits and includes courses such as probability, statistics, and quantitative methods; accounting for managers; strategic issues and applications; healthcare decision making; finance issues & applications in healthcare; economic issues and applications in healthcare; digital innovation in healthcare; and regulatory issues in healthcare management.

• Location: Cleveland, OH
• Accreditation: Higher Learning Commission (HLC); Association to Advance Collegiate Schools of Business (AACSB International)
• Expected Time to Completion: Two years
• Estimated Tuition: $1,561 per credit

Depending on which of the certifications pursued, one will likely need to renew those various certifications periodically. Most of NABIP’s credentials, for example, are valid for at least two years, depending on the concentration, so all certified members should ensure they keep track of renewal requirements.

NABIP offers the Registered Employee Benefits Consultant (REBC) designation, which provides up-to-date training in a constantly evolving industry. In this online training program, professionals learn the current provisions, advantages, and limitations of benefit programs related to the Affordable Care Act (ACA), marketing, underwriting, and more.

Most of the content focuses on group medical expense plans related to employers and employees. Courses include diversity, equity, and inclusion in the modern workplace; single-payer healthcare certification; and account-based health plans certification.

NABIP members gain access to networking and business training for health insurance underwriters. To renew the REBC certification, professionals must self-report 24 hours of continuing professional credit (CPC) hours every two years. Those who hold multiple designations through NABIP can use these credits to maintain all current designations. This certification typically takes 15 to 24 months and is offered online.

The Institutes offers several online health insurance underwriter certifications, including the Chartered Property Casualty Underwriter, or CPCU designation. The CPCU certification is available to health insurance underwriters with two years of experience. The certification requires nine courses divided into four categories: core, concentration, elective, and ethics. Each course takes four to six weeks, and the coursework and exams are offered online. Other health insurance underwriter certifications offered by the Institutes include the Associate in Commercial Underwriting (AU) and the Associate in Personal Insurance (API).

Health insurance underwriters, agents, and claims representatives who earn this certification can join the CPCU Society to connect with nearly 18,000 professionals. Half-priced dues are available to those in the process of completing their CPCU certification. CPCU certification lasts for two years and can be renewed by providing 24 hours of continuing education credits. The average time it takes to earn this certification is two to three years.