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Underwriting HIV Series Part III:  Building a Qualified Team

Thu, 30 Jun 2016 13:25:16 +0000 / by Bill Berthiaume


With the recent news of a major Canadian Life Insurance Company offering coverage to individuals with HIV, our three-part-blog series has explored various elements of how this major change affects the industry, companies and underwriters alike. While we discussed how to switch the perspective of an underwriter as well as the intricacies & concerns for underwriting HIV+ clients - we haven’t addressed the impact on an underwriting team.

As an underwriting manager myself, when I first heard about this, I had to take a step back to think about how my team could successfully tackle and embrace this industry change. In fact, several key questions came to mind, some that you may be wondering as well.

Is a dedicated HIV Underwriting department needed or just a few select individuals? What type of people should one be looking for to address this type of case?  What experience levels does one want or need?  Is there specialized training involved?  If so, how does one get this training?  What sort of quality controls need to be put in place? 

If you are in the same boat and looking to answer these critical questions, then you’ve come to the right place! Find my answers below and learn how to build a qualified team that is equipped with the knowledge and resources to underwrite HIV cases.

What kind of case volume are we dealing with?

As of 2012 there were approximately 1.2 million Americans living with HIV and as of 2014, around 75,000 in Canada.  For those individuals, life insurance is very difficult to obtain and very expensive if it can be.  Thus, your audience of who might be able to afford this type of life insurance is going to be a very select few.  Most likely we are looking at business professionals, athletes or those in the entertainment industry. Realistically, the volume expectations will be very low.    

How many underwriters should I allocate to HIV cases?

To assemble a team or group of individuals to do the underwriting, initially you’ll need to define and select underwriters that you feel can handle the intricacies of this type of risk assessment.  How many underwriters you need, will again depend on your volume expectations. BUT my recommendation would be to start building the expertise with approximate three or four experienced underwriters.

What level experience should underwriters have if dealing with HIV cases?

The people you choose to form this team should have senior level experience and have at the minimum, demonstrated a very strong technical ability to underwrite. Excellent communication skills are also essential as underwriters need to be able to present their cases to doctors and communicate results/decisions to the field. Strong documentation skills are also a must. The underwriters you chose should have significant expertise in this discipline.

PRO TIP: Have your underwriters master their documentation skills with our Proper File Documentation eLearning module.

Finally, having a medical director(s) at the ready, to provide the appropriate initial training, ongoing support and guidance thereafter would be extremely beneficial.

What kind of training will ensure that my team is well-equipped with the necessary knowledge?

Since the underwriting of HIV is in its infancy, we don’t really have a database of past cases to pull from and review.  We are more or less learning as we go. However, the underwriters will need to understand the ideology, pathology, complications and treatment of HIV. A critical component of this training, as mentioned above, will be the doctor(s) involved. They will have to provide a solid base level of how this condition is to be underwritten.

PRO TIP: Given that you wouldn’t have a lot of historical examples to work with, I would suggest implementing ongoing case clinics after an HIV case is completed to give your team exposure to it and to build a strong knowledge base.

What quality controls can I put in place to ensure proper efficiency and that quality decisions will be made?

Once the initial training has been provided and you go live with the underwriting, you’ll need to then ensure that you have adequate quality controls in place. Again, we don’t have much precedence to follow here, but as we’ve indicated in our series, we have a solid foundation of what to look for in terms of underwriting HIV cases.

Initially, each underwriter would work up his/her own case which would then be discussed/reviewed with the medical director. If, as expected, the volumes of HIV+ cases are very low, there would be an opportunity to discuss these cases with other HIV underwriters, doctor(s) and potentially a medical committee made up of the Chief Underwriter(s), Medical Director (s), Head of Mortality Risk Management, Senior Underwriters. Similar to the case clinics I mentioned, this gives the underwriters involved the chance to discuss each scenario and outcome with one another while building a knowledge base and expertise within. This ensures that consistent, quality decisions can be made going forward. 

Thereafter, I would implement weekly meetings to discuss recent cases, keeping the conversation top of mind. I would also suggest to roll out monthly audits to ensure decisions are accurate, contributing to future consistency.

Communication will be key amongst all those involved.

In summary, when it comes to building the right team to address HIV+ cases, one needs to:

  • Allocate team members according to the volume of business
  • Select underwriters with the right level experience and technical expertise
  • Look for individuals with strong communication and excellent documentation skills
  • Have a dedicated medical director as an accessible resource for medical knowledge and training
  • Implement quality controls to build consistency and ensure quality decisions moving forward

With no precedence for underwriting HIV in our industry, what are your predictions for the future?

How do you think underwriting teams should be structured?! Let me know in the comments section below! 

Topics: Underwriting, Life Insurance

Bill Berthiaume

Written by Bill Berthiaume

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