Unpaid Claims - Reconciliation (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Liability for Unpaid Claims and Claims Adjustment Expense, Activity in Liability [Abstract]
Cumulative incurred claims, net	$ 3,369,971	$ 2,385,940	$ 1,547,806
Less: cumulative paid claims, net	3,232,576	$ 2,249,623	$ 1,443,830
Net unpaid claims, including claims adjustment expenses	$ 137,395