The posting
AT A GLANCE
Medical, dental, and vision coverage
Location: Remote (US)
Work from home; occasional travel may be required for training or team events
Job
Full-time
US work authorization required
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ROLE OVERVIEW
The PEO Underwriter is responsible for evaluating, pricing, and managing risk for new and renewing PEO groups within a co‑employment model. This role requires strong analytical skills, comfort with complex datasets, and the ability to interpret carrier documentation, claims trends, and regulatory requirements. You will own cases end‑to‑end, collaborate with cross‑functional teams, and ensure underwriting decisions support profitability, compliance, and operational accuracy.
This position is ideal for candidates with 1–3 years of experience in health insurance underwriting, benefits administration, or related analytical roles who are ready to take on full underwriting responsibility in a fast‑paced PEO environment.
KEY RESPONSIBILITIES
SUBMISSION REVIEW
- Independently prioritize underwriting requests across new business, renewals, off‑cycle changes, and census updates.
- Review submissions for completeness, including census files, prior carrier invoices, renewal packets, plan designs, eligibility rules, SIC codes, and participation details.
- Assess case complexity and determine appropriate underwriting timelines based on SLAs and effective dates.
DATA VALIDATION & RISK ASSESSMENT
- Audit census data for missing fields, formatting inconsistencies, dependent mismatches, ZIP code anomalies, and eligibility flags.
- Validate prior carrier documentation including rates, contribution structures, enrollment counts, and renewal methodologies.
- Analyze claims experience, loss ratios, credibility, and trend factors to support pricing decisions.
- Apply underwriting principles within a PEO/MEWA framework, including risk pooling, composite rating, and multi‑state regulatory considerations.
PRICING & UNDERWRITING DECISIONS
- Develop and deliver pricing recommendations for new and renewing groups, ensuring alignment with profitability targets and carrier guidelines.
- Identify risk drivers such as participation issues, demographic shifts, high‑cost claimants, and plan migration patterns.
- Prepare underwriting summaries and rationale for internal stakeholders and carrier partners.
CROSS‑FUNCTIONAL COLLABORATION
- Work closely with brokers, sales teams, and internal partners to clarify missing or unclear submission information to prevent delays.
- Partner with Compliance to support ACA affordability testing, eligibility determinations, and regulatory adherence.
- Collaborate with Benefits Operations (BenOps), Implementation, and Payroll/HRIS teams to ensure downstream processes receive clean, accurate data.
OPERATIONAL EXCELLENCE
- Maintain organized underwriting files, documentation, and audit trails in accordance with internal and carrier standards.
- Ensure PHI and sensitive data are handled securely and in compliance with HIPAA and internal protocols.
- Contribute to continuous improvement initiatives, including workflow enhancements, data quality improvements, and underwriting playbook updates.
REQUIRED SKILLS & QUALIFICATIONS
- Bachelor’s degree in Finance, Mathematics, Statistics, Computer Science, Economics, or a related analytical field.
- 1–3 years of experience in health insurance underwriting, benefits administration, actuarial support, or related analytical roles.
- Strong attention to detail with a focus on data accuracy and quality.
- Proficiency working with large datasets, employee census files, and spreadsheet‑based analysis.
- Clear written and verbal communication skills, with the ability to translate technical underwriting concepts for brokers and internal stakeholders.
- Strong Excel or Google Sheets skills; ability to learn new platforms quickly.
- Ability to manage multiple cases and deadlines while maintaining high accuracy.
- Self‑starter who can work independently while collaborating effectively with senior underwriters and cross‑functional teams.
NICE TO HAVE
- Exposure to PEO, ASO, or group health insurance concepts.
- Familiarity with ACA compliance, COBRA, or benefits administration workflows.
- Experience with HRIS, benefits admin, or payroll platforms.
- Progress toward or interest in AHIP, LOMA, or other underwriting/actuarial certifications.
