Which role evaluates risk and determines eligibility for coverage?

• A. CSR
• B. Insurance Broker
• C. Underwriter
• D. Adjuster

Answer: (C)

Evaluating risk and deciding eligibility for coverage is the role of the underwriter. In health insurance, the underwriter reviews the applicant’s information—medical history, age, current health status, lifestyle factors, and sometimes occupation or hobbies—and uses underwriting guidelines to judge how risky the applicant is to insure. Based on that assessment, they determine whether to issue the policy and, if so, under what terms, such as the premium, policy limits, and any exclusions or riders. They may categorize risk as standard, preferred, substandard, or decline coverage.

This differs from a customer service representative, who handles enrollment and policy questions; a broker, who helps clients compare and acquire coverage; and a claims adjuster, who evaluates a claim after coverage is in force to decide payment.