Job Group Summary
Underwriting directly helps our company achieve financial and strategic goals. As the financial professionals who identify and calculate risk, underwriters are charged with increasing revenues, earnings and membership while protecting the company from loss.

Family Summary/Mission
Support Aetna's ability to achieve its financial and strategic goals through effective Underwriting. Underwriting primarily includes identifying, evaluating, and managing risk in order to maximize revenue, membership and earnings.

Position Summary/Mission
Medical Underwriting (or evidence) is required when a Proof of Good Health statement must be submitted and approved in order for an underwritten (late) applicant and/or eligible dependent to obtain life, disability, medical, long term care and/or dental coverage. Individual and group medical risk analysis is conducted by assessing medical and policy data and verifying Evidence of Insurability. Underwriting decisions are made by applying consistent risk analysis standards and are required when one or more of the following conditions exists for a request for: benefits outside of the eligibility period; reinstatement of previously canceled coverage; life insurance which exceeds the plan's guaranteed standard issue; a higher option disability plan; multiple increase in life insurance; dependent coverage which was initially refused. The medical underwriter manager establishes medical underwriting policy and supervises underwriters to ensure cost-effective risk management, quality customer service and maximum enrollment.

Fundamental Components & Physical Requirements

• Develops, documents and implements medical underwriting policy consistent with plan objectives.

Establishes procedures and develops workflow to ensure quality service and timely response to customers.

• Develops and maintains contacts with professional associations and authorities in the medical field to facilitate the development of underwriting policy and standards.
• Selects, trains and develops medical underwriting staff Conducts performance audits to assure correct interpretation and application of policy.
• Underwrites complex medical questionnaires and/or medical records.
• Assesses risks and makes sound underwriting decisions based on established criteria and/or medical judgments.
• Communicates with customers regarding the underwriting process.
• Reviews all appeals and advises management of unusual situations.
• Participates in analyzing trends in claim experience and recommends areas of underwriting criteria for review and modification.
• May manage additional functions as part of overall functional.
• Participates in projects that have significant business-wide implications.
• Engages in underwriting decisions with significant benefit implications.
• Underwrites complex medical questionnaires and/or medical records.
• Assesses risks and makes sound underwriting decisions based on established criteria and/or medical judgments.

Background Experience Desired
Experience leading and developing staff.
Fluent in written and spoken English.
Experience making presentations to senior executives, brokers, insurers, etc.
Proven leadership skills and strong cross-functional relationships with internal and external constituents.
Extensive insurance industry knowledge with clinical background.
Proven ability to anticipate customer needs and negotiate with customers using tact and diplomacy.

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