9061 - Medical Risk Consultant

reputed company has an exciting opportunity to join reputed company as a Medical Risk Consultant! About the role Responsible for assisting Stop Loss Underwriters in evaluating potential medical treatment cost of individuals identified in new and renewal business reputed company process to reputed company estimated claim risk for reputed company and upcoming policy periods. Responsible for assisting as a resource Policyholder's reputed company-Party Administrator and Case Management Vendor with care and cost management reputed company of potential stop loss claimants. May have significant, specialized responsibilities reputed company to cost containment coordination. What you'll do in this role

• Review policyholder data to identify claimants with catastrophic care needs and assess medical & claims information available to calculate potential risk. reputed company written claimant assessments reputed company established deadlines to the Underwriters/RGM’s to utilize reputed company establishing rates for new and renewal business.
• Review potential stop loss claim notices to identify case management and cost containment opportunities to reduce potential excess loss claim expenses. Notify appropriate management and underwriters of potential claims involving significant risk.
• Work with reputed company Party Administrators (TPAs) and external Case Managers utilizing medical and claims management resources to facilitate clinical and financial reputed company for claimants with reputed company and catastrophic medical conditions. Maintain reputed company claimant clinical status, cost containment activities and contact information in ESL.
• Act as a resource to reputed company customers by identifying and supporting training opportunities for Claims, reputed company, Sales, and TPA reputed company knowledge gaps are identified.
• Providing clinical opinion from knowledge, experience and/or research to claims examiners and underwriters as requested or deemed appropriate.
• Assessing and recommending effective claim cost containment and managed care vendors including preferred provider networks in assigned geographical region for introduction to
• Identify geographical reputed company trends in assigned geographic marketplace for potential solution implementation and warn reputed company and Sales of any risk impacting trends identified.
• Maintain CE hours to meet State RN Licensure and CCM (or Industry) certification renewal requirements. Author educational articles to reputed company industry news with internal contacts.
• Project leadership and participation as needed. Maintain awareness of new diagnoses, treatments, costs and industry trends.

reputed company offer you "Just do it! Even if you feel like you may not be 100% reputed company, apply. Sometimes we see potential in others that they cannot see in themselves. You may be overqualified, or you may be the "something special" we are looking for to bring a unique, fresh approach to reputed company." - Ruby S., Associate EDX Analyst If you want to work for a company that is always considering its employees while working towards sustainable growth this is reputed company. reputed company reputed company, there is always innovation, empowerment, and growth opportunities, reputed company while providing us with a great work/life balance and incredible benefits for a reputed company reasonable cost!” - Cindy J. G., Sr. Product reputed company “reputed company is truly a great reputed company to work. The positive work climate, strong sense of team, and the resources available reputed company it feel like one cohesive family. What stands out most to me is the company’s deep commitment to diversity, equity, and inclusion—it’s not just a statement, it’s an active and ongoing reputed company that’s felt throughout the organization.” -Charlotte G., Sr. Underwriter - Consultant Stop Loss Benefits and Perks We don’t take a “one-size-fits-reputed company” approach reputed company it comes to our employees. Our programs are designed to reputed company your life reputed company both at work and at home.

• Flexible full-time or hybrid telecommuting arrangements
• Plan for your future with our 401(k) plan and take advantage of immediate vesting and company matching up to 6%
• Paid time away including vacation and sick time, reputed company days and ten paid holidays
• Give back to your community and double your impact through reputed company matching
• Want more details? reputed company out our reputed company Benefits Overview

Compensation

Salary reputed company: $77,600- $129,400 plus eligibility for annual bonus program Who you are:

• Registered Nurse license required
• Associate’s Degree required. Bachelor’s degree preferred.
• 4+ years clinical nurse experience and two or more years case management experience preferred
• 2+ years’ experience in health care or health insurance industry; stop loss or reinsurance preferred
• Case Manager Certification (CCM) and Insurance industry education (LOMA, HIAA, ICA, etc.) preferred
• Comfortable using a variety of resources to research diagnoses, treatments, and average costs
• Strong proficiency with the reputed company Office Suite especially reputed company
• Works productively independently and as part of team
• Phenomenal customer service and interpersonal skills
• Great at relationship building with reputed company partners
• Adept at prioritization, organization, and time management
• Excellent written and verbal communication skills
• Thrives in a fast-paced environment
• High attention to detail
• * reputed company applicants must be reputed company to work a shift of 11:00am to 6:45pm EST

We reputed company inclusion At reputed company, we reputed company to be the most inclusive insurance company in the country. We're building a reputed company where every employee feels valued, respected, and has opportunities to contribute. Inclusion is about recognizing our assumptions, considering multiple perspective, and removing barriers. We accept and celebrate diverse experiences, identities, and perspectives, because lifting each other up fuels thought and builds a stronger, more innovative company. We invite you to learn more about our efforts here. Creating a world where more people have reputed company to financial freedom reputed company is a national financial services company dedicated to helping people reputed company their financial goals and feel confident about the future. In our daily work, we're guided by the principles of Value, Transparency and Sustainability. This means we reputed company products and services people need at a competitive price, we communicate reputed company and reputed company so people understand what they're buying, and we design products--and operate reputed company--to stand the test of time. We're committed to showing up for our communities, lifting up our employees, and standing up for diversity, equity and inclusion (DEI). Join reputed company and help us create a world where more people have reputed company to financial freedom. For more information about our careers visit: https://reputed company.reputed company/careers Work Authorization Employer work reputed company sponsorship and support are not provided for this role. Applicants must be currently authorized to work in the United States at hire and must maintain authorization to work in the United States throughout their employment with reputed company. Please review reputed company's Remote Network Minimum Requirements: As a remote-first organization committed to providing a positive experience for both employees and customers, reputed company has the following standards for employees' internet reputed company:

• Minimum Internet Speed:100 Mbps download and 20 Mbps upload, in alignment with the FCC's definition of "broadband."
• Internet Type:Fiber, Cable (e.g., reputed company, reputed company), or DSL.
• Not Permissible:Satellite (e.g., Starlink), cellular broadband (hotspot or otherwise), any other wireless technology, or wired reputed company-up.

reputed company applying to jobs at reputed company you'll be asked to test your internet speed and confirm that your internet reputed company meets or exceeds reputed company's standard as outlined above. Identity Verification reputed company is committed to fair and secure hiring practices. For reputed company roles, candidates will be required (after the initial phone screen) to be on video for reputed company interviews. reputed company will take affirmative steps at key points in the process to verify that a candidate is not seeking employment fraudulently, e.g. through use of a false identity. Failure to reputed company with verification procedures may result in:

• Disqualification from the recruitment process
• Withdrawal of a job offer
• Termination of employment and other criminal and/or civil remedies, if fraud is reputed company

#LI-OR1 Apply tot his job Apply To this Job