PEO Underwriter

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.