Health Underwriter

Introduction

We are seeking an experienced Health Underwriter responsible for assessing and evaluating health insurance applications, determining risk levels, and making informed decisions to approve or decline coverage. The successful candidate will demonstrate strong analytical capability, sound judgement, and the ability to interpret complex medical information, while ensuring compliance with underwriting standards and regulatory requirements.

Duties & Responsibilities

Risk Assessment & Underwriting

• Evaluate health insurance applications by reviewing medical histories, reports, and relevant supporting documentation.
• Assess risk associated with pre-existing conditions and overall health profiles.
• Determine appropriate coverage terms in line with underwriting guidelines and risk appetite.
• Document underwriting decisions clearly, including rationale for approvals, loadings, exclusions, or declines.
• Ensure consistency in underwriting decisions and adherence to turnaround times.
• Escalate complex cases and underwriting exceptions where required.
• Stay up to date with medical advancements, treatments, and industry trends to support accurate risk assessments.

Compliance & Documentation

• Ensure all underwriting decisions comply with company policies, industry regulations, and legal requirements.
• Maintain accurate and detailed records of all underwriting decisions and supporting documentation.
• Support the development and continuous improvement of underwriting policies, guidelines, and procedures.
• Ensure protection of sensitive medical and personal information in line with data privacy regulations.
• Identify and report any compliance breaches or data risks.

Team Support & Development

• Provide guidance and support to junior underwriters and new team members.
• Assist with onboarding and training initiatives within the underwriting team.
• Promote a culture of continuous learning, collaboration, and high performance.
• Contribute to the review and improvement of underwriting standards and practices.
• Support implementation of new policies and ensure team adherence.

Stakeholder Engagement & Communication

• Communicate underwriting decisions and rationale clearly and professionally to internal stakeholders, brokers, and clients.
• Respond to queries, resolve disputes, and provide detailed explanations where required.
• Escalate complex or sensitive cases appropriately.
• Build and maintain strong relationships with brokers, clients, and internal teams.
• Participate in internal and external meetings, presentations and discussions as required.

Process Improvement & Innovation

• Identify opportunities to improve underwriting processes and efficiency.
• Contribute to projects aimed at enhancing underwriting systems, tools, and methodologies.
• Support implementation of new technologies and workflow improvements.
• Monitor industry trends and best practices to ensure competitiveness and continuous improvement.
• Collaborate with IT and other departments to streamline processes.

Desired Experience & Qualification

Minimum Requirements

• Minimum 25 years experience in health underwriting ( non-negotiable ), preferably within the medical aid or health insurance industry.
• Proven experience in assessing medical risk and interpreting clinical information.
• Strong understanding of underwriting principles, policies and risk evaluation.

Qualifications

• Bachelors degree in a relevant field (e.g., Nursing, Medicine, Life Sciences, Business or similar).
• Professional underwriting certification (advantageous).
• Postgraduate qualification (advantageous).

Key Competencies

• Strong analytical and decision-making skills
• High level of accuracy and attention to detail
• Ability to interpret complex medical information
• Excellent communication and interpersonal skills
• Strong organisational and time management skills
• Ability to work independently and within a team
• High level of professionalism, integrity and confidentiality

Additional Requirements

• In-depth knowledge of medical conditions, treatments, and healthcare industry practices
• Ability to manage multiple cases within strict turnaround times
• Strong stakeholder engagement and relationship management skills

Package & Remuneration

R28 000.00 R35 000.00.

Interested?

Please mail your CV to hr1 (at) peopledimension (dot) co (dot) za

Shortlisted applicants will be contacted within 2 weeks, if you do not hear from us by then your application for this position was unsuccessful, but you have been added to our database for future vacancies.