Medical Risk Consultant

Berkshire Hathaway Specialty Insurance•Plymouth Meeting, PA

15d•$90,000 - $120,000•Remote

About The Position

BHSI has an exciting opportunity for a medical risk consultant to join their medical stop loss team. The ideal candidate will utilize professional and clinical knowledge to assess risk. These activities will provide BHSI medical stop loss underwriters, claim auditors and external clients with appropriate clinical assessment of the anticipated care needs and potential costs of identified claimants.

Requirements

Bachelor’s Degree, or equivalent combination of education and work experience
Registered Nurse license required
5+ years of clinical experience
Excellent oral, written, and interpersonal communication skills
Ability to work in high volume, rapid response environment
Ability to multi-task and shift priorities as needed
Exceptional attention to detail and strong organizational skills are imperative
Verified knowledge of ESL Office, particularly the Underwriting, Claims and Policy Administration modules
Working knowledge of Microsoft Excel

Nice To Haves

2+ years of medical stop loss experience, preferred
Working knowledge of stop loss insurance policy and contract language
Experience with Excel; PDFs; AMS; David Young System (or similar software supporting stop loss), preferred

Responsibilities

Evaluate and assess both new business and renewal large claims, disclosures, clinical data, and claims data to identify known risks, potential risks, and make projected risk recommendations to the stop loss underwriting team.
Quickly, thoroughly, and accurately assess a potential and/or actual claim to successfully influence risk decision makers, resulting in meaningful clinical and/or financial outcomes.
Effectively communicate and document claim projections and rationale to stop loss underwriters.
Effectively explain complex clinical conditions and treatments utilizing knowledge base, experience, and/or research as requested to internal and external clients.
Build strong relationships with internal (Underwriters, Claims) and external clients (Third Party Administrators, external Case Managers) to communicate risk factors and projected cost of claims.