Key Responsibilities and Required Skills for A&H Underwriting Manager

🎯 Role Definition

As the A&H Underwriting Manager you will lead underwriting strategy and day‑to‑day decisioning for Accident & Health (A&H) products—individual and group disability, critical illness, medical stop‑loss and related coverages. This role combines technical underwriting expertise, portfolio management, and cross‑functional leadership to deliver profitable growth, maintain disciplined risk selection, and ensure regulatory and operational excellence. You will partner with actuarial, pricing, claims, distribution, product and reinsurance teams to refine underwriting guidelines, set appetite, approve exceptions, and optimize throughput with digital tools and analytics.

📈 Career Progression

Typical Career Path

Entry Point From:

Senior A&H Underwriter
A&H Portfolio or Risk Analyst
Actuarial Associate supporting A&H lines

Advancement To:

Head / Director of A&H Underwriting
VP of Underwriting — Individual & Group Products
Chief Underwriting Officer (specialty or line-of-business)

Lateral Moves:

Product Management – A&H or Group Benefits
Pricing/Actuarial Lead (A&H)
Underwriting Operations / Systems Manager

Core Responsibilities

Primary Functions

Lead the development, maintenance and enforcement of A&H underwriting guidelines and appetite statements for individual and group disability, life, critical illness, and stop‑loss products to ensure consistent, standardized risk selection across channels.
Oversee daily underwriting decisions for complex, high‑severity and exception submissions, making final approvals on escalations and mentoring underwriters on judgmental and nuanced risk selection.
Manage the A&H underwriting portfolio for profitability and growth by monitoring experience, loss trends, persistency and lapse data and implementing corrective actions to address adverse selection or pricing drift.
Partner closely with actuarial and pricing teams to translate risk segmentation and loss experience into underwriting rules, rate adjustments, underwriting rate bands and referral thresholds.
Design and oversee exception and approval workflows including delegated authority frameworks, ensuring appropriate controls, SLA adherence and audit trails for compliance and audit readiness.
Lead underwriting reviews and remediation plans following experience investigations, reserving changes, regulatory exams or claims pattern shifts, and present findings and recommended actions to senior leadership.
Build and deliver underwriting scorecards, KPIs and management reporting that track hit‑rates, approval rates, referral volumes, turnaround times and profitability metrics to inform tactical and strategic decisions.
Negotiate facultative and treaty reinsurance terms with internal and external reinsurance partners; collaborate with the reinsurance team to optimize retention, ceding strategy and treaty utilization.
Collaborate with product managers to design, test and launch new A&H products and riders, ensuring underwriting rules, eligibility criteria and pricing inputs are aligned with target markets and distribution strategies.
Implement and champion digital underwriting initiatives—including rules engines, automated decisioning, e‑app integrations and evidence‑based underwriting—to increase straight‑through processing and reduce manual touchpoints.
Conduct regular portfolio risk reviews (by product, distribution channel, broker, geography and grouping) to identify concentration risk, emerging morbidity trends, and to set targeted actions (pricing, limits, exclusions).
Drive continuous improvement of underwriting processes by leading root cause analyses on exceptions, disputes and claims leakage, introducing controls and workflow changes to reduce operational risk and cycle time.
Provide underwriting support to distribution and wholesale brokers on complex cases, competitive positioning and product suitability, including preparation of underwriting memoranda for strategic accounts.
Ensure regulatory compliance across jurisdictions for A&H underwriting practices, policy issuance, rating, and disclosures; coordinate timely responses to regulatory inquiries and filings.
Define and deliver training programs, competency matrices and career development plans for underwriting staff to build technical depth in morbidity, benefit structures, and underwriting evidence interpretation.
Serve as the underwriting liaison to claims and medical directors to investigate chronic or systemic claim drivers, adjust underwriting standards where appropriate, and align claims and underwriting risk mitigation strategies.
Lead vendor and data partnerships for external medical databases, motor vehicle records, prescription history, and predictive health data; validate vendor models and ensure responsible use of data in underwriting.
Oversee underwriting compliance controls, internal audits and quality assurance programs including file sampling, peer reviews and corrective action tracking to maintain high standards of underwriting discipline.
Manage P&L ownership for assigned A&H product lines or books of business, owning budget, expense controls, loss ratios, and profitability drivers while supporting growth objectives.
Drive cross‑functional initiatives to improve customer experience from quoting through policy issuance, working with distribution, IT and operations to streamline processes and reduce time to bind.
Represent underwriting in mergers, acquisitions and portfolio transfers, performing due diligence, assessment of risk selection, and designing transition plans for continuity of underwriting governance.
Create and present executive-level underwriting strategy updates, portfolio health reviews and recommended strategic initiatives to senior management and the Board when required.

Secondary Functions

Support ad‑hoc data requests and exploratory data analysis to help identify underwriting improvement opportunities and emerging morbidity trends.
Contribute to the organization's underwriting data strategy and roadmap, informing selection of analytics tools, data sources and automation priorities.
Collaborate with business units (actuarial, product, claims, distribution, IT) to translate underwriting needs into system requirements and process changes.
Participate in sprint planning, agile ceremonies and testing cycles for underwriting systems enhancements and straight‑through processing initiatives.
Assist legal and compliance teams with policy wording reviews, regulatory submissions and responses related to underwriting practices and exceptions.
Mentor and participate in hiring, onboarding and performance reviews for underwriting and underwriting support staff.

Required Skills & Competencies

Hard Skills (Technical)

Deep technical knowledge of Accident & Health (A&H) product underwriting: group and individual disability, life, critical illness, and stop‑loss.
Strong experience interpreting medical evidence, attending physician statements, specialty reports, functional capacity evaluations and integrating clinical data into underwriting decisions.
Ability to translate actuarial outputs and morbidity analyses into underwriting rules, segmentation and case acceptance criteria.
Reinsurance knowledge: facultative and treaty mechanics, treaty utilization, quota share, excess of loss, and negotiation of reinsurance terms affecting underwriting.
Proficiency with underwriting and policy administration systems, rules engines, straight‑through processing tools and vendor integrations (e.g., underwriting workflow platforms).
Data literacy: ability to work with underwriting analytics, build and interpret management reports, and run ad‑hoc queries using SQL or equivalent data tools.
Strong Excel modeling skills and experience reviewing/prioritizing predictive model outputs (propensity or risk models) used in evidence‑based underwriting.
Familiarity with regulatory requirements for A&H underwriting and rating, privacy (e.g., HIPAA), and anti‑discrimination rules affecting underwriting practices.
Experience with performance dashboards and BI tools (Tableau, Power BI or similar) to visualize portfolio health and KPIs.
Proven track record of managing underwriting authority, exceptions, delegated authority programs and establishing control frameworks.

Soft Skills

Strategic leadership with the ability to set underwriting direction, influence senior stakeholders and translate strategy into operational execution.
Strong judgment and decision‑making under uncertainty; ability to justify outcomes with both qualitative and quantitative evidence.
Excellent communication and presentation skills to convey complex risk issues to non‑technical stakeholders, brokers and executive teams.
Coaching and people development skills to grow high‑performing underwriting teams and foster continuous learning.
Stakeholder management and collaboration across cross‑functional teams including actuarial, claims, product, distribution and IT.
Negotiation skills, particularly in handling large cases, reinsurance terms and broker relationships.
Change management capability to lead system implementations, process redesigns and cultural adoption of data‑driven underwriting practices.
Problem solving and analytical mindset with attention to detail and a focus on process quality and operational control.
Customer‑centric orientation to balance risk discipline with distribution needs and improve broker/agent experience.
Time management and prioritization in a high‑volume environment with competing strategic and operational priorities.

Education & Experience

Educational Background

Minimum Education:

Bachelor's degree in Finance, Business, Actuarial Science, Life Sciences, Nursing, or related field.

Preferred Education:

Advanced degree (MBA, M.S.) or professional insurance designations such as CPCU, FLMI, ARe, or actuarial credentials (ASA/ACAS) relevant to A&H.
Certifications or continuing education in underwriting analytics, risk management or life/health insurance.

Relevant Fields of Study:

Actuarial Science
Finance or Economics
Health Sciences, Nursing or Medical fields
Business Administration / Management

Experience Requirements

Typical Experience Range: 7–12+ years in Accident & Health (A&H) insurance underwriting, with at least 3–5 years in a supervisory or lead underwriting role.

Preferred:

Demonstrated experience managing A&H underwriting teams, delegations and complex case workflows.
Experience partnering with actuarial/pricing and claims functions and participating in product launches and reinsurance negotiations.
Proven track record of driving underwriting automation, evidence‑based underwriting adoption, and delivering measurable improvements in loss ratios, cycle times or expense ratios.