Underwriter (Pet & Health) at Oneplan Underwriting Managers (Pty) Ltd

Role Summary

• Own end-to-end clinical underwriting decisions for pet insurance, ensuring accurate risk selection, fair outcomes, clear client communication, and audit-ready documentation—across sales, online applications, moving-insurer cases, and post-claim loadings.

Key Responsibilities

Core Clinical Underwriting

• Assess disclosed conditions (including “Other”) and apply appropriate underwriting outcomes (exclusions, loadings, or standard acceptance).
• Document clear clinical rationale in Questions/Condition Notes and underwriting fields.
• Ensure decisions align with underwriting appetite, product rules, and fair treatment standards.

Sales & Online “Other” Workflows

• Review cases routed from Pending QA or online Advanced Underwriting.
• Perform Correction Calls where required to explain outcomes and obtain acceptance.
• Finalize policies to New once all requirements are met.

Moving from Another Insurer

• Request and evaluate proof of cancellation and prior cover confirmation (and claims history where needed).
• Assess whether the 60-day illness waiting period may be waived, based on continuity and risk.
• Communicate decisions and rationale to clients; record acceptance.

Post-Claim Underwriting

• Review approved claims referred by Claims Assessors; determine and apply post-claim premium loadings.
• Conduct Correction Calls; issue written confirmation and updated policy schedules.

Communication, Quality & Compliance

• Deliver clear, empathetic client explanations in plain language.
• Maintain high-quality notes, evidence of acceptance, and compliant document handling.
• Participate in peer reviews, audits, and continuous improvement initiatives.

Collaboration

• Work closely with Sales QA, Claims, and Ops to resolve data gaps, streamline routing, and improve client outcomes.
• Provide feedback to Product/Policy on trends (conditions, claims, and risk appetite).

Job Requirements
Qualifications & Experience

• Required: Clinical veterinary knowledge and experience (e.g., BVSc/DVM or equivalent clinical background in small animal practice).
• Preferred: 2–5+ years’ experience in small animal medicine/surgery or pet insurance underwriting.
• Advantageous: Familiarity with insurance products, underwriting principles, and waiting period frameworks; exposure to South African insurance context and customer fairness principles.
• Long Term, medical insurance, Medical Aid, RE 5 / 1 Preferrable
• Strong written and verbal communication skills; comfortable conducting client calls about complex medical/insurance topics.

Skills & Competencies

• Clinical reasoning & risk assessment
• Decision-making with sound judgment and consistency
• Excellent client communication (verbal and written)
• Documentation discipline and audit readiness
• Collaboration and stakeholder management
• Time management across queues and SLAs
• Tech-savvy with policy admin/CRM tools and call systems
• Performance Metrics (Examples)
• SLA adherence (assessment turnaround, call follow-ups, document chasing).
• Quality: completeness of notes; audit pass rate; accuracy of decisions.
• Client outcomes: acceptance rate; complaint ratio; call QA score.
• Throughput: cases finalized per week.