Location: 

Windsor, CT, US

 

Clinical Risk Manager - Employer Stop Loss 

About Swiss Re

Swiss Re Corporate Solutions provides risk transfer solutions to large and mid-sized corporations around the world. Its innovative, highly customised products and standard insurance covers help to make businesses more resilient, while its industry-leading claims service provides additional peace of mind. Swiss Re Corporate Solutions serves clients from over 50 offices worldwide and is backed by the financial strength of the Swiss Re Group.

 

CLINICAL RISK MANAGER

We have an exciting opportunity for an experienced Clinical Risk Manager to join our team in any one of these locations: Windsor, CT; Kansas City, MO; Schaumburg, IL. Do you have a strong clinical/disease state management/case management background? Are you looking to enter the insurance sector in a clinical nurse consultant role? We are looking to use your knowledge to project expected claim costs based on ICD 9 / ICD 10 codes, current treatment plan and other pertinent medical information.

 

About the Role

This exciting role will complete medical risk analysis for stop loss underwriters for potential ongoing risk on new business cases and in-force renewals. The primary function of this role is to evaluate large claimants and predict ongoing future claim costs relative to the stop loss individual specific level. This risk evaluation is presented to the stop loss underwriter who will use the information to determine how best to offset or mitigate the catastrophic risk, which could impact the overall marketability of the case.

 

About the Team

SUMMARY OF ESSENTIAL FUNCTIONS

-  Do you enjoy reviewing medical conditions; analyzing the costs to aid Underwriters in completing a cost analysis in preparation of a Stop Loss quote?

-  You will be responsible for providing individual medical risk analysis on large and small claimants for proposed stop loss new business and renewal business

-  We are looking for someone who will identify high risks associated with individuals and communicate required stop loss attachments based on your medical

-  Do you enjoy researching rare/complicated medical conditions/treatments? We have a variety of tools and resources available to help forecast costs and share your knowledge of various diseases.

-  We handle a high volume of work during peak periods to support the Underwriters busy season

-  Prepares and documents a medical review summary with an analysis of current clinical conditions and potential future claim projections to Underwriting staff; documenting in the system

-  We encourage CRM's to create training material to update Underwriting staff on new medical treatment options available in the marketplace

-  Comply with departmental policies and procedures

 

About You

REQUIRED EDUCATION AND EXPERIENCE

-  Strong analytical and problem solving skills

-  Excellent organizational and time management skills, able to work independently with little direct management oversite while handling numerous projects at once

-  Ability to negotiate with Underwriters and Sales Professionals

-  Excellent written/verbal communication skills, especially the ability to communicate effectively in stressful situations

-  Do you have a track record of producing work that is highly accurate, demonstrates attention to detail, and reflects well on the organization

-  RN with current state licensure and at least 2 years’ experience

-  Computer experience should include Microsoft Excel, Word and Outlook at the intermediate level at a minimum

-  We are willing to train you about stop loss insurance and the underwriting process and computer systems.

 


Keywords:  
Reference Code: 83472 

 


Nearest Major Market: Hartford

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