Senior Analyst - Medical Underwriting

Tawteen; Muscat; On-site; OMR 35,000 - 50,000; Full time

Job summary

Tawteen is seeking a Senior Analyst in Medical Underwriting to perform comprehensive underwriting assessments for individual and group health insurance by evaluating medical risks and analyzing clinical information to support pricing decisions. The role emphasizes governance, profitability, and collaboration with internal and external stakeholders.

The candidate will analyze morbidity and mortality risks, manage complex cases, and contribute to underwriting guidelines and strategic initiatives.

Qualifications

• Minimum 8–10 years of experience in medical underwriting or related health insurance areas.
• Experience in individual and group medical underwriting; strong medical risk assessment.
• Experience with morbidity/mortality analysis and healthcare cost management.
• Proficient in ICD, CPT, DRG coding knowledge.
• Advanced Excel and Power BI skills for reporting and analytics.

Responsibilities

• Evaluate applications through medical history review of records and treatment plans.
• Assess morbidity and mortality risks to guide underwriting decisions.
• Manage high-value and complex cases including pre-existing conditions.
• Support pricing teams with medical opinions and cost projections.
• Develop and enhance underwriting guidelines and risk frameworks.
• Collaborate with claims, reinsurers, and brokers on complex cases.
• Produce reports, dashboards, and management presentations.

Skills

Medical underwriting

Risk assessment

Data analysis

Stakeholder management

Analytical thinking

Attention to detail

Portfolio management

Claims analysis

Regulatory compliance

Education

Bachelor's Degree in Medicine/Health Sciences/Insurance or related healthcare

ALMI / LOMA or equivalent professional qualifications

Tools

Excel

Power BI

Job description

Job Description

Senior Analyst - Medical Underwriting

Department: Medical Underwriting

Health Insurance Reporting To: Manager - Medical Underwriting

Head of Underwriting

Job Purpose To perform comprehensive medical underwriting assessments for individual and group health insurance business by evaluating medical risks analyzing complex clinical information supporting pricing decisions and ensuring adherence to underwriting guidelines The role is responsible for maintaining profitability through sound risk selection effective portfolio management and collaboration with internal and external stakeholders

Key Responsibilities

Medical Underwriting amp Risk Assessment

• Evaluate individual and group medical insurance applications through detailed assessment of medical history clinical records diagnostic reports and treatment plans
• Analyze morbidity and mortality risks to determine appropriate underwriting decisions
• Assess high-value and complex medical cases including chronic illnesses multi-morbidity profiles and pre-existing conditions
• Recommend acceptance exclusions loadings postponements or declinatures in accordance with underwriting guidelines
• Conduct medical necessity evaluations and risk classification for various health insurance products

Pricing amp Portfolio Management

• Support pricing teams by providing medical opinions risk assessments and cost projections
• Contribute to portfolio profitability through effective risk selection and adverse selection mitigation
• Review claims experience utilization trends and healthcare cost drivers to support underwriting decisions
• Assist in developing underwriting strategies for corporate and group medical schemes

Underwriting Governance amp Process Improvement

• Develop review and continuously enhance medical underwriting guidelines manuals and risk frameworks
• Ensure compliance with internal underwriting policies regulatory requirements and reinsurance standards
• Identify opportunities for automation operational efficiency and underwriting process improvement
• Participate in underwriting system enhancements and digital transformation initiatives

Claims amp Risk Management Support

• Collaborate with claims teams on complex medical claims and policy interpretation matters
• Review high-cost claims trends and provide recommendations to control risk exposure
• Assist in fraud detection investigation reviews and risk mitigation activities
• Support claim adjudication through medical expertise when required

Stakeholder Management

• Provide technical underwriting guidance to brokers sales teams customer service teams TPAs and healthcare providers
• Liaise with reinsurers regarding underwriting referrals and complex medical cases
• Address underwriting queries and escalations from internal and external stakeholders
• Deliver underwriting training and knowledge-sharing sessions

Data Analysis amp Reporting

• Analyze underwriting data claims trends and portfolio performance metrics
• Prepare underwriting reports dashboards and management presentations
• Utilize analytical tools to support evidence-based underwriting decisions
• Monitor underwriting quality and key risk indicators

Education

Bachelor's Degree in Medicine, Health Sciences, Insurance, Nursing, Pharmacy, or related healthcare discipline. Professional insurance qualifications such as ALMI, LOMA, or equivalent are preferred.

Experience

Minimum 8-10 years of experience in medical underwriting, health insurance, reinsurance, or related healthcare insurance functions. Experience in individual and group medical underwriting. Strong exposure to medical risk assessment, claims analysis, and healthcare cost management.

Knowledge amp Technical Skills

Medical underwriting principles and practices. Clinical case evaluation and interpretation of medical reports. Morbidity and mortality assessment. Health insurance products, policy wordings, and underwriting guidelines. Claims management and medical necessity assessment. ICD, CPT, DRG coding knowledge. Advanced Excel, Power BI, and reporting tools. Understanding of reinsurance and healthcare risk management practices.

Competencies

Analytical and critical thinking. Attention to detail. Risk assessment and decision-making. Problem-solving capability. Communication and stakeholder management. Team collaboration. Process improvement mindset. Customer and service orientation. Time management and prioritization.