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 to quantify the risk to the insurance provider of taking on a particular patient, in addition to attempting 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 taken into consideration to underwrite 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 in another field. What matters most in gaining an entry-level position is one’s ability to demonstrate competency in the areas of 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 go on to obtain master’s degrees in business (MBA) or health administration (MS, MHA). Both types of programs tend to 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 (2021), 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 $80,390 (BLS May 2020).

Health insurance underwriters can earn certification through various professional organizations:

• National Association of Health Underwriters (NAHU)
• 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), in addition to any other educational requirements. Associations, organizations, and societies allow professionals to network with other people in the field and to 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 who 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, a focus on mathematics, statistics, science, and business will benefit any prospective health insurance underwriter. If available, take Advanced Placement (AP) courses in these subjects.

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

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 any special training or certification, applicants generally need either 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.

In terms of advocacy, training, and development, the National Association of Health Underwriters (NAHU) leads the market of professional health insurance societies. There are many more general authorities on insurance underwriting, such as the Insurance Institute of America (IIA) and 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.

NAHU 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, NAHU ethics in business, consumer-directed healthcare, and benefits technologies.

In addition to these resources, NAHU 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 the sale, improvement, and service of 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

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

NAHU 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 as it relates to employers and employees. Courses include diversity, equity, inclusion in the modern workplace, single-payer healthcare certification, and account-based health plans certification.

NAHU 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 NAHU can use these credits to maintain all current designations. This certification typically takes 15 to 24 months to complete and is offered entirely 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 to complete, and the coursework and exams are offered entirely 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 are eligible to 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.