Windsor, CT, US


Team Lead Clinical Risk Manager 

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.


About You

We have an exciting opportunity for an experienced Clinical Risk Manager Lead to join our team in any one of these locations: Windsor, CT and Schaumburg, IL.  Ideal candidates would have experience as a Clinical Risk Manager in the insurance or reinsurance marketplace. 


About the Role

This position is responsible for the management of a team of Clinical Risk Managers who review case management notes for individuals and groups seeking Stop Loss Insurance quotes.  The incumbent works closely with Underwriters to evaluate potential risk and associated costs with projected treatments.  


Summary of Essential Functions
• Manage workflow including workflow adjustments during high volume periods, as assigned by Senior Management
• Provide employees with guidance in handling difficult or complex problems or in resolving escalated complaints or disputes.
• Implement corporate or departmental policies, procedures, and service standards
• Responsible for ensuring each member of the Clinical Risk Management department is aware of the direction of the department and that they are provided opportunity for successful management of their Clinical Risk Management case load relative to service and financial goals.
• Manage inter-departmental relationships with Underwriting, Business Services, Sales and Claims resolving issues appropriately.
• Review medical conditions and respond with a cost analysis integrated to the Stop Loss case characteristics.
• Identify high risk associated with individuals and communicate required stop loss attachment
• Document all decisions in the clinical documentation system
• Recommend appropriate laser levels using Underwriting guidelines.
• Utilizes external medical experts as needed.
• Conduct daily tracking of caseload as assigned
• Comply with departmental policies and procedures
• Participate in departmental and company in-services as appropriate
• Perform other duties as assigned by Senior Management



About the Role


Required Education and Experience

  • Strong analytical and problem solving skills
  • Two or more years of supervisory or equivalent experience
  • Excellent organizational and time management skills, able to work independently with little supervision while handling numerous projects at once
  • Excellent written/verbal communication skills, especially the ability to communicate effectively in stressful situations
  • Must 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


Reference Code: 83472 


Nearest Major Market: Hartford

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