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

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