When it comes to underwriting, many steps are involved to ensure underwriters have the most accurate information when evaluating an individual for insurance, mortgages, loans, investments, and more. Most financial environments give underwriters full reign of investigation; however, Obamacare has limited the ability of insurance companies to set insurance rates based on individuals’ health history and pre-existing conditions. Some insurance companies can still utilize this common practice when client onboarding to assess the company’s overall risk in coverage.

What is the role of an underwriter?

There are many types of underwriters, but most fall under the financial or health industries. Both roles examine an individual’s financial or medical records and other documents to decide if their company should take them on. Underwriters assess the risk any new client presents when evaluating their application.

Financial underwriters work for mortgage, insurance, loan, or investment companies. Financial underwriting is the practice of determining the risk factor of an applicant when they apply for a mortgage, loan, or investment opportunity. They must look at all available data to decide if an individual is at high risk. If the applicant is approved and cannot return the money owed, the underwriter is accountable for the loss.

Similar to financial underwriting, medical underwriting is the practice of determining the risk factor of an applicant when deciding the price of insurance coverage. This is often used in health, life, and disability insurance rates. A medical underwriter evaluates an individual’s medical history by accessing their medical records, demographic profile, lifestyle, and other factors affecting the applicant’s medical needs. Many people insist medical underwriting ensures individual health premiums remain low for most customers. However, others claim it prevents individuals with minor pre-existing conditions from procuring health insurance. All these factors make underwriting a stressful and complex career to manage. 

How do medical records impact an underwriter?

Most underwriters who use medical records are health and life insurance underwriters. When an underwriter takes on a new application, their process can vary depending on the type of application they receive. An applicant’s health and medical record history are vital in the decision-making of an underwriter as these medical records provide valuable insight into the applicant’s health and their overall risk to the insurance company.

Since the COVID-19 pandemic began, many underwriters have turned to Electronic Health Records (EHRs) to access applicant’s medical records in a timely and efficient manner. Their job is to research all information regarding the applicant’s health history and decide whether the applicant can be approved for insurance. Although Obamacare has put a limit to set life insurance rates depending on a patient’s health history, the main role of an underwriter is to do just that. When it comes to life insurance, there are four types of underwriting involved:

Full Underwriting: This process is the traditional underwriting method and requires the applicant to fill out a detailed questionnaire as well as take a medical exam before being approved by the underwriter.

Accelerated Underwriting: Also known as no-exam underwriting, accelerated underwriting is similar to full underwriting, but doesn’t include the medical exam. This type of insurance method is competitively priced and still requires an investigation into the applicant’s medical history.

Simplified Issue: This process entails only a handful of questions to be answered. If an applicant responds yes to any of the questions, they do not achieve insurance coverage. Because of this simplified process, the issue policy tends to be much more expensive.

Guaranteed Issue Life Insurance: There are no questions or medical exams for this type of insurance policy; however, it is the most expensive way to obtain life insurance. This type of coverage is meant for individuals with pre-existing health conditions that make it impossible to get insurance any other way.

How has Wisedocs streamlined medical record reviews for underwriters?

Wisedocs is an integral part of processing medical records for insurance investigations. When an underwriter compiles the medical record data for an application, they can expedite the medical record review process and provide more detailed results and insights for the insurance companies using a medical document processing platform such as Wisedocs. With our automated artificial intelligence platform, insurance firms can easily streamline the electronic medical record review process, organize, and summarize the medical records faster for its validity.  

For example, Wisedocs streamlined the processing of medical briefs by up to 70% for our medical assessments client, CVE Inc., improving their document workflow and healthcare claim processing.

Wisedocs provides reliable scalability, insights, and medical data using document intelligence. Our automation can help insurance companies scale everything, from reimbursements and underwriting to case analysis.

If you are an underwriter in the medical insurance industry, get in touch with our team for a full demo.