Underwriter (Hybrid), Contracting & Network Development (Full-time, Day)

Prisma Health; Greenville (SC); On-site; USD 100,000 - 150,000; Full time

Job summary

Prisma Health is seeking a seasoned underwriter to manage stop-loss and related health insurance underwriting. The role focuses on evaluating risks, developing pricing models, and guiding proposals with sales teams.

The candidate will work closely with brokers, payers, and internal departments to optimize profitability and ensure regulatory compliance. The position demands 7–10 years of underwriting experience, familiarity with underwriting software, and strong analytical and communication

Qualifications

• Bachelor’s degree in Business, Finance, or a related field.
• 7–10 years of underwriting and risk assessment experience.
• Experience with stop‑loss and health insurance products welcome.

Responsibilities

• Develop underwriting programs, policies, and guidelines to ensure profitability.
• Review stop‑loss offers and advise on pricing and terms for proposals.
• Create financial models for forecasting, budgets, and KPI analysis.
• Communicate with partners on risk levels and forecasted claims costs.
• Maintain records of underwriting decisions and ensure regulatory compliance.

Skills

Underwriting

Risk assessment

Pricing analysis

Communication skills

Attention to detail

Team collaboration

Education

Bachelor's degree in Business or Finance

Tools

Underwriting software

Spreadsheets

Job description

Inspire health. Serve with compassion. Be the difference.

Job Summary

Responsible for underwriting new and renewal medical stop loss business which includes reviewing, evaluating, selecting, and rating each risk to maximize premium revenue while meeting enterprise profit margins and production goals. Responsible for any other applicable products that require and allow underwriting of risk.

Essential Functions

• All team members are expected to be knowledgeable and compliant with Prisma Health's purpose: Inspire health. Serve with compassion. Be the difference.
• Responsible for the development, implementation, and maintenance of underwriting programs, policies, procedures, and guidelines to ensure compliance and profitability.
• Reviews Group health insurance applications and medical records to evaluate risk. Uses underwriting software, A.I. tools and actuarial manuals to calculate rates, premiums, and factors. Performs detailed pricing analysis and contribute to pricing strategies to optimize profitability.
• Reviews stoploss offers and makes recommendations to the sales team on which stoploss offer to use when building Promise Health Plan proposals, based on pricing and contract terms.
• Creates and updates financial models for forecasting and budgeting. Conducts analyses to identify key metrics for modeling financial data (revenue, cost, expenses, KPIs). Compiles data on yearly loss ratios and medical trends for program evaluation.
• Communicates with stop-loss partners regarding risk levels and forecasted claims costs on new and renewing business.
• Consults with payer staff to obtain information, review insurance laws, and explain underwriting policies.
• Collaborates with internal teams to understand monthly trends and ensure comprehensive risk evaluation.
• Develops and maintains strong relationships with brokers, agents, and reinsurers.
• Prepares detailed reports and documentation to support health plan decisions.
• Maintains accurate records of underwriting decisions and related data.
• Ensures compliance with legal standards and stays current on industry regulations and legislative changes.
• Conducts regular audits of underwriting files to ensure quality and compliance.
• Informs enterprise payer strategy, including forecasting and approach for insurance products.
• Serves on work groups or process improvement teams to enhance quality and customer satisfaction.
• Performs other duties as assigned.

Supervisory/Management Responsibilities: This is a non-management job that will report to a supervisor, manager, director, or executive.

Minimum Requirements

• Education - Bachelor’s degree in Business, Finance, or related field
• Experience - 7-10 years of related experience in Medical underwriting and risk assessment

In Lieu Of

N/A

Required Certifications, Registrations, Licenses

Active medical/health underwriting certification

Knowledge, Skills And Abilities

• Knowledge of insurance principles, policies, and regulations
• Attention to detail
• Effective communication and negotiating skills, both written and verbal
• Ability to work collaboratively in a team environment
• Proficient in using underwriting software and tools
• Knowledge of underwriting self-funded and converting fully insured prospects into self-funded products
• Basic computer skills including word processing, spreadsheets, database and data entry
• Knowledge of office equipment (fax/copier)
• Mathematical skills

Work Shift

Day (United States of America)

Location

Prisma Health Corporate Office

Facility

7002 Value-Based Care and Network Services

Department

70029344 Contracting & Network Development

Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.