17 Medical Underwriter Interview Questions and Answers

Medical underwriters work in the insurance industry. They review medical records to determine whether an insurance company should provide coverage to an individual or business.

When interviewing for a medical underwriting job, you will be asked a variety of questions about your experience, qualifications, and skills. You may also be asked questions about the insurance industry and your knowledge of underwriting principles.

To help you prepare for your interview, we have compiled a list of sample medical underwriter interview questions and answers.

Are you familiar with the HIPAA Privacy Rule?

The Health Insurance Portability and Accountability Act (HIPAA) is a federal law that protects the privacy of an individual’s medical records. Employers ask this question to make sure you understand how HIPAA affects your work as a medical underwriter. In your answer, explain what the Privacy Rule is and why it’s important for you to follow it.

Example: “Yes, I am familiar with the HIPAA Privacy Rule. As someone who works in healthcare, I know how important it is to protect patient information. The Privacy Rule outlines specific guidelines about how we can use and disclose protected health information. For example, if I need to share a patient’s information with another party, I must have their written consent first.”

What are some of the most important factors that you consider when making a medical underwriting decision?

This question can help the interviewer determine how you prioritize your work and what skills you use to complete it. Use examples from previous experience that show you understand the importance of each factor and how you apply them in your decision-making process.

Example: “I think the most important factors when making a medical underwriting decision are the applicant’s age, gender, occupation, health history and lifestyle. Age is an important factor because it helps me determine if the applicant has any pre-existing conditions or chronic illnesses that may require additional coverage. Gender is also important because some diseases and conditions are more common among one sex than the other. Occupation is important because I can see if they have a dangerous job or if their job requires them to be on their feet all day.

Health history is important because it shows me whether the applicant has had any past illnesses or injuries that could affect their current application. Lifestyle is important because it gives me insight into the applicant’s habits and behaviors that may impact their health.”

How do you determine whether a particular condition is a pre-existing condition?

Medical underwriters often need to make decisions about whether a patient’s medical condition is pre-existing. This question helps the interviewer assess your decision-making skills and ability to apply them in this role. In your answer, describe how you would approach this task and what factors you would consider when making your determination.

Example: “I would first look at the time between the initial diagnosis of the condition and the application date. If it was less than 12 months, I would likely deem it as a pre-existing condition. Another factor I would consider is if the applicant had any knowledge of their condition before applying for coverage. For example, if they were diagnosed by a physician but did not disclose that information on their application, then I would also consider it a pre-existing condition.”

What is your process for evaluating the severity of a condition when making a coverage decision?

This question can help the interviewer understand how you apply your knowledge of medical terminology and procedures to make decisions that affect a company’s bottom line. Use examples from previous experience to show how you use critical thinking skills to analyze information and make informed decisions.

Example: “I first look at the diagnosis, which is usually listed as the primary reason for treatment or care. I then read through the list of symptoms to get an idea of what the patient may be experiencing. From there, I check the duration of the condition and its frequency. Finally, I review any additional notes about the patient’s overall health and compare this information with the severity of their current condition.”

Provide an example of a time when you had to deny coverage based on an applicant’s medical history. What was your reasoning?

This question is a great way to assess your decision-making skills and ability to handle conflict. When answering this question, it can be helpful to provide an example of how you handled the situation in a professional manner while still maintaining good customer service.

Example: “In my previous role as a medical underwriter, I had to deny coverage for a patient who was applying for life insurance. The applicant had a history of heart disease, which would have made him ineligible for coverage. Instead of denying his application outright, I explained that he could apply again once he reached the age where he no longer had any risk factors. He understood the reasoning behind my decision and reapplied when he turned 65.”

If an applicant is approved for a policy but you know they have a condition that isn’t currently covered, what would you do?

This question is a great way to see how an applicant would handle a situation that could arise in their role. It’s important for medical underwriters to be able to make decisions and act on them, so this question can help you determine if the applicant has the ability to do so.

Example: “If I knew of a condition that wasn’t currently covered but was likely to occur within the next year or two, I would contact the client and explain the situation. If they agreed to wait until the policy was up for renewal before applying again, I would allow them to renew with the new coverage. However, if they insisted on continuing with the current policy, I would have to decline the application.”

What would you do if you suspected an applicant was lying about their medical history?

An interviewer may ask this question to assess your ability to detect fraud. They want to know that you can use your skills and knowledge to make sure the applicant is honest about their medical history. In your answer, explain how you would handle such a situation and what steps you would take to ensure the applicant’s honesty.

Example: “If I suspected an applicant was lying about their medical history, I would first try to get more information from them. If they were still not being truthful, I would contact their doctor or hospital to see if there are any records of their diagnosis. If they have no record of treatment for the condition they claim to have, then I would deny their application.”

How well do you perform under pressure?

Employers ask this question to see how you react in a high-pressure situation. They want to know that you can perform well even when the stakes are higher than usual. In your answer, explain what strategies you use to stay calm and focused under pressure. Share an example of a time when you had to work under pressure and succeeded.

Example: “I am someone who thrives under pressure. I find that it motivates me to do my best work. When I have a tight deadline or need to meet certain standards, I make sure to plan ahead as much as possible. This helps me feel more confident about my ability to succeed. In my last role, I was tasked with reviewing thousands of applications for a new insurance program. We needed to hire hundreds of people within a short period of time. I used my planning skills to ensure I could get through all the applications on time.”

Do you have experience working with insurance software?

The interviewer may ask this question to learn more about your experience with the software they use at their company. If you have worked with similar software in the past, share what you liked and disliked about it. If you haven’t used insurance software before, explain that you are willing to learn how to use it if hired.

Example: “I’ve never worked with insurance software before, but I am familiar with other types of software like customer relationship management systems. In my last role, I had to enter data into a database for our CRM system. It was tedious work, but I learned how to do it well. I think I could apply those same skills to working with insurance software.”

When is it appropriate to request an applicant’s medical records?

This question can help the interviewer determine your knowledge of HIPAA regulations. It also shows how you apply that knowledge to make decisions about an applicant’s health insurance application.

Example: “HIPAA requires medical underwriters to request applicants’ medical records only when it is necessary for a decision on their application. For example, if I am unsure whether or not an applicant has a pre-existing condition, I may ask for their medical records so I can review their history and make a more informed decision. If I do need to request records, I will always ensure they are returned within 30 days. This helps me avoid any fines from the Department of Health and Human Services.”

We want to improve our approval rate. What strategies would you suggest?

This question is a great way to show your problem-solving skills. You can use it as an opportunity to demonstrate how you would analyze the current approval rate and develop strategies to improve it.

Example: “I would first look at the reasons why we’re rejecting claims, then I’d work with my team to implement solutions that help us approve more claims. For example, if we have too many denials because of pre-existing conditions, I would suggest we create a list of medical conditions that are automatically approved. This will allow us to focus on other factors when deciding whether or not to approve a claim.”

Describe your process for verifying an applicant’s identity when they submit a medical history.

The interviewer may ask you a question like this to understand how you apply your knowledge of identity theft and fraud prevention techniques in the workplace. Use examples from previous experiences that show your ability to perform thorough background checks on applicants and verify their information.

Example: “I first check for inconsistencies between an applicant’s name, address, date of birth and social security number. If I find any discrepancies, I will contact them directly to confirm whether or not they submitted the application. After confirming the applicant’s identity, I then run a search through public records databases to ensure there are no criminal convictions or outstanding debts associated with their name. Finally, I conduct a credit report to make sure there aren’t any recent inquiries or accounts that don’t match up with what the applicant has provided us.”

What makes you an ideal candidate for a medical underwriter position?

Employers ask this question to learn more about your qualifications and how you feel they align with the job. Before your interview, make a list of reasons why you are qualified for this position. Consider including any relevant experience or education that makes you an ideal candidate.

Example: “I am passionate about helping people find affordable healthcare options. I have worked in customer service before, so I know how important it is to help customers find solutions to their problems. In my previous role as a medical underwriter, I helped patients understand their insurance plans and find doctors who accepted their coverage. This helped them save money on their healthcare costs.”

Which industries have you worked in previously?

Employers ask this question to learn more about your background and experience. They want to know if you have any relevant work experience in the insurance industry. If you do, they may be more likely to hire you because you will already understand how the company works. If you don’t have previous experience, explain what industries you worked in and why you are interested in working for an insurance company.

Example: “I’ve worked as a medical underwriter for five years now. I started out as a receptionist at a small insurance agency before moving to a larger one where I gained valuable experience. Now, I’m ready to take on a new challenge and apply my skills to a different type of insurance company.”

What do you think is the most challenging part of this job?

Employers ask this question to see if you are aware of the challenges that come with working as a medical underwriter. They want someone who is willing to take on these challenges and use their skills to overcome them. When answering, think about what you find challenging in your current role or other jobs you have held. Try to focus on challenges that can be solved by using your skills and abilities.

Example: “The most challenging part of this job is making sure I am following all of the company’s guidelines when deciding whether an applicant should receive coverage. There are so many factors involved in this decision, and it can be difficult to remember everything. However, I have developed a system for remembering which factors are important to consider. This has helped me make more accurate decisions.”

How often do you make mistakes when verifying medical histories?

This question can help the interviewer determine how often you make mistakes and what your process is for correcting them. It also helps them understand whether or not you have a system in place to ensure you don’t repeat these errors. When answering this question, it’s important to be honest about your past mistakes but highlight your ability to learn from them.

Example: “I’ve made several small mistakes when verifying medical histories, however I always take time to review my work before submitting it to ensure that I haven’t missed anything. If I do find an error, I immediately contact the applicant so they can correct their information and resubmit it. This allows me to avoid making the same mistake twice.”

There is a bug in the insurance software that you use to process claims. What is your response?

This question is a test of your problem-solving skills. It also shows the interviewer how you would respond to an error in the software that could affect your work.

Example: “I would first try to fix the bug myself, but if I couldn’t, I would report it to my supervisor and ask for help from IT. If they can’t resolve the issue, I will contact the insurance company’s customer service department so they can inform the developer about the bug. This way, we can ensure that the bug is fixed as soon as possible.”