Underwriting interview prep.

Behavioural questions to expect

1. Walk me through your background + underwriting experience.
2. Tell me about a book of business you've underwritten or analysed.
3. Why payor underwriting vs other actuarial / underwriting paths?
4. Why this line of business / segment?
5. Why the firm?
6. What's your read on our lines of business + market position?
7. Tell me what you understand about our financial + MLR + Stars performance.
8. Walk me through a pricing or underwriting decision for a specific line of business.

Technical concepts to master

• ACA commercial + group + individual underwriting

  Modified community rating · Guaranteed issue + renewal · Experience rating (large group) · Self-insured + stop-loss · Rate filing + DOI

• Medicare Advantage bid + Stars

  MA bid process · MA Stars rating · MA risk adjustment (RAF) · RADV + audit risk · MA benefit design + supplemental

• Risk adjustment + HCC + RAF

  HCC (Hierarchical Condition Categories) · RAF (Risk Adjustment Factor) · HCC capture + chart review · RA reconciliation · HHS Risk Adjustment (ACA)

• Provider network economics + value-based contracts

  UCR + fee schedule · Network adequacy + tiering · Capitation · Shared savings + bundled payments · Medical management + utilisation review

Practical drills

• A 250-employee group is up for renewal. Last year MLR was 92% on $4.2M premium. They're shopping. Walk through your pricing analysis + renewal recommendation.
• Your MA plan's RAF score dropped 3% YoY in mid-year submission. Walk through your diagnostic + response.
• A major hospital system is asking for a 12% rate increase. They handle 35% of your members' inpatient admits. Walk through your analytical + negotiation approach.

Smart-question anchors

• Lines of business + market - commercial / MA / Medicaid mix, geographic focus
• Financial performance - MLR, MA Stars, RA reconciliation, line profitability
• Underwriting org - functional structure, market vs national, actuary vs underwriter roles
• Provider network strategy - broad / narrow / tiered, value-based contracting depth
• Risk adjustment posture - HCC capture, RA reconciliation, audit history

Sourced from

CMS Medicare Advantage Rate Announcement + bid instructions · CCIIO + HHS ACA Rate Review + Risk Adjustment rules · NAIC Model Acts + state DOI rate filing standards · SOA + Academy of Actuaries health practice notes · Milliman + Oliver Wyman + Wakely actuarial reports + Kaiser Family Foundation