Clinical Risk Manager
Swiss Re is one of the world’s leading providers of reinsurance and insurance, and they are seeking an experienced Clinical Risk Manager to join their Accident & Health division. The role involves analyzing medical conditions and associated costs, collaborating with underwriters to evaluate risk, and managing documentation for high-risk individuals.
Responsibilities
- Review medical conditions and respond with a cost analysis coordinated to the Stop Loss case characteristics. Including 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
- Utilize provided clinical resources such as Predict Dr., NCCN, NORD, and CDC
- Supply and manage documentation with clinical summary and estimated cost of services for each individual identified as at risk
Skills
- Minimum of Associate or Bachelor's degree in nursing with at least 1 year of Stop Loss Nursing experience
- Must have up to date registered nurse (RN) license
- Able to demonstrate a track record of producing work that is highly accurate, shows attention to detail, and reflects well on the organization
- Proven experience managing multiple projects and working well while handling large volumes of work (with deadlines)
- Excellent written and verbal communication skills
- Computer proficiency, specifically strong typing skills and Internet research skills, must have a clear understanding of Microsoft Word, Microsoft Office and Excel
- Strong clinical background in disease state management/case management experience
- Background in a Clinical Risk Management position is encouraged but will consider qualified candidates especially those with an oncology or cardiology background
- Strong analytical and problem-solving expertise
- Excellent interpersonal skills enabling successful navigation of cross-functional collaboration
- Ability to prioritize well and work independently with little direct supervision, while handling numerous projects at once
Company Overview
Company H1B Sponsorship