Becoming a Health Insurance Underwriter - Education, Experience & Certifications

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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 which 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 are used to automatically underwrite insurance applications through systems of simple machine learning and adaptive assessments, but the human touch is still a critical component of the insurance industry. It is important that health insurance underwriters 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 reports that health insurance underwriters make an annual national average of $53,448, with possibilities for up to $7,000 in bonuses in certain higher-paying markets in major cities.

These professionals can also consider applying for certification through various insurance underwriting organizations:

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 give professionals an opportunity to network with other people in the field and to tap into a rich body of knowledge.

Where Do Health Insurance Underwriters Work?

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 a large number of customer accounts, or in hospitals, specialist offices, and clinics where low-cost programs are available.

Steps to Becoming a Health Insurance Underwriter

There are any number of ways to 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.

Step 1: Earn an associate’s or bachelor’s degree (two to four years).

As a high school student, a focus in mathematics, statistics, science, and business will benefit any prospective health insurance underwriter. AP courses in these subjects are recommended.

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 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. As per employer discretion, a few years of industry experience could go a long way to making oneself a desirable candidate for employment.

Step 2: Gain industry experience to help prepare for certification and more advanced positions (one to five years).

While most entry-level health insurance underwriting positions do not require any special training or certification, they generally require 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 certification sought, the amount of experience required could be anywhere from one to five years.

Step 3: Apply for certification and/or state-required license based on a health insurance underwriting concentration (one to two years).

In terms of organizations of advocacy, training, and development, the National Association of Health Underwriters (NAHU) leads the market of professional health insurance societies. There are also a handful of 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 certifications in underwriting for the affordable care act and patient protection, a benefits account manager certification, and an 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 (e.g., California Department of Insurance) for information on credentialing.

Step 4: Earn a master’s degree to increase expertise and earnings (optional, one to three years, depending on program)

Attending 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 with a focus on insurance underwriting can open the door to the top—the highest-achieving level of insurance underwriting. One can expect 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

Step 5: Become a certified health insurance professional and/or renew necessary certifications (timelines vary).

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.

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