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Location: 

Windsor, CT, US Schaumburg, IL, US

Clinical Risk Manager

 

About Swiss Re Corporate Solutions
 

Swiss Re is one of the world’s leading providers of reinsurance, insurance and other forms of insurance-based risk transfer. We anticipate and manage risks, from natural catastrophes and climate change to cybercrime.

Swiss Re Corporate Solutions is the commercial insurance arm of the Swiss Re Group. We offer innovative insurance solutions to large and midsized multinational corporations from our approximately 50 locations worldwide. We help clients mitigate their risk exposure, whilst our industry-leading claims service provides them with additional peace of mind.

Swiss Re Corporate Solutions offers a flexible working environment where curious and adaptable people thrive. Are you interested in joining us?

 

About the Role

We have an excellent opportunity for an experienced Clinical Risk Nurse Consultant to join our organization in any one of these locations: Windsor, CT or Schaumburg, IL. Preference is to find an applicant in these offices but willing to consider qualified individuals in other locations. This position requires a strong clinical background in disease state management/case management experience. A background in a Clinical Risk Management position is encouraged but will consider qualified candidates especially those with an oncology or cardiology background. This position is ideal for applicants looking to enter the insurance sector in a nurse consultant role. In this position you have the responsibility to use your knowledge and experience to project expected treatment costs based on ICD 9 / ICD 10 codes, current treatment plan and other pertinent medical information.

About the Team

As a member of the team you will review, assess and evaluate treatment plans, large claims reports, shock reporting for individuals and groups seeking Stop Loss Insurance quotes. The incumbent works closely with Underwriters to evaluate potential risk and associated costs determined by the Clinical Risk Manager projected treatments and risk for cost analysis.

Summary of Principal Job Functions

  • We are seeking applicants who will review medical conditions and respond with a cost analysis coordinated to the Stop Loss case characteristics. This would include the review and assessment of large claim reports, shock claim summary reports, trigger reports and large case management notes.
  • Identify high risk associated with individuals and communicate required stop loss cost analyzation of current clinical conditions and future cost projections.
  • Will be provided with access to clinical resources such as Predict Dx, NCCN, NORD, and CDC.
  • Fulfill other duties as assigned by Team Lead.

 

 

About You

  • Do you have strong analytical and problem-solving skills?
  • Excellent interpersonal expertise, ability to prioritize, able to work independently with little direct supervision, while handling numerous projects at once
  • Excellent written and verbal communication
  • Documentation with clinical summary and estimated cost of services for each individual identified as at risk
  • Able to demonstrate a track record of producing work that is highly accurate, shows attention to detail, and reflects well on the organization
  • Bachelor's degree in nursing with current state licensure and at least 3-5 years of clinical experience
  • Computer proficiency, specifically strong typing skills and Internet research skills, must have a clear understanding of Microsoft Word, Microsoft Office and Excel.

 

Swiss Re is an equal opportunity employer. It is our practice to recruit, hire and promote without regard to race, religion, color, national origin, sex, disability, age, pregnancy, sexual orientations, marital status, military status, or any other characteristic protected by law. Decisions on employment are solely based on an individual's qualifications for the position being filled.

During the recruitment process, reasonable accommodations for disabilities are available upon request. If contacted for an interview, please inform the Recruiter/HR Professional of the accommodation needed.

 

Keywords: 
Reference Code: 98103 

 

 


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