Clinical Risk Manager

Swiss Re - Schweizerische Rückversicherungs-Gesellschaft; Schaumburg (IL); Hybrid; USD 84,000 - 140,000; Full time

Job summary

A leading insurance company is seeking an experienced Clinical Risk Manager for their Accident & Health division. This position requires a strong nursing background, preferably with experience in disease state management. Responsibilities include reviewing medical conditions with associated cost analyses and collaborating closely with underwriters. The ideal candidate has excellent analytical skills, attention to detail, and an RN license. The role offers a hybrid work model based in Schaumburg, IL, with a salary range of $84,000 to $140,000.

Qualifications

• 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.

Responsibilities

• Review medical conditions and respond with a cost analysis.
• Identify high risk associated with individuals and communicate required stop loss cost analysis.
• Supply and manage documentation with clinical summary and estimated cost of services.

Skills

Analytical skills

Problem-solving skills

Interpersonal skills

Attention to detail

Communication skills

Education

Associate or Bachelor's degree in nursing

Tools

Microsoft Word

Microsoft Office

Excel

Job description

Swiss Re uses a hybrid work model requiring at least three days in the office each week.

This position can be based near one of our Swiss Re offices, including (but not limited to) Alpharetta, GA – Windsor, CT – Schaumburg, IL.

We have an excellent opportunity for an experienced Clinical Risk Manager to join our team in Swiss Re's Accident & Health division!

About the Role

This position requires a strong clinical background in disease state management/case management experience. A background in a Clinical Risk Management position is encouraged but will consider qualified candidates especially those with an oncology or cardiology background. This position is ideal for applicants looking to enter the insurance sector in a nurse consultant role.

In this position you have the responsibility to use your knowledge and experience to project expected treatment costs based on ICD 9 / ICD 10 codes, current treatment plan and other pertinent medical information.

Principal responsibilities include:

• 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

About the Team

The Clinical Risk team brings value to Swiss Re working in close collaboration with Underwriters to determine and evaluate potential risk and associated costs of projected treatments and care. We are a welcoming team of nurses who are passionate about what they do. Diversity and Inclusion are a part of our winning culture. We believe that our individual performances contribute to the success of the team.

About You

You bring your strong analytical and problem-solving expertise! Your excellent interpersonal skills enable you to successfully navigate cross-functional collaboration.

You have an ability to prioritize well and work independently with little direct supervision, while handling numerous projects at once.

Additional requirements include:

• 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

The estimated base salary range for this position is $84,000 to $140,000. The specific salary offered for any given role will take into account a number of factors including but not limited to job location, scope of role, qualifications, complexity/specialization/scarcity of talent, experience, education, and employer budget. At Swiss Re, we take a "total compensation approach" when making compensation decisions. This means that we consider all components of compensation in their totality (such as base pay, short-and long-term incentives, and benefits offered), in setting individual compensation.