Clinical Risk Manager

Swiss Re; Windsor (CT); Hybrid; USD 84,000 - 140,000; Full time

Job summary

A leading insurance company based in the United States is seeking an experienced Clinical Risk Manager for its Accident & Health division. This role focuses on clinical risk management, requiring strong analytical skills and an active RN license. Responsibilities include reviewing medical conditions and providing cost analysis while collaborating with underwriters. The position offers a hybrid work model and a competitive salary ranging from $84,000 to $140,000.

Qualifications

• Minimum of 1 year of Stop Loss Nursing experience.
• Active, up-to-date registered nurse (RN) license.
• Must manage multiple projects and large volumes of work.

Responsibilities

• Review medical conditions and provide cost analysis.
• Identify high risk individuals and communicate required cost analysis.
• Utilize clinical resources effectively.

Skills

Analytical skills

Problem-solving skills

Interpersonal skills

Attention to detail

Project management

Communication skills

Education

Associate or Bachelor's degree in nursing

Tools

Microsoft Word

Microsoft Office

Microsoft Excel

Job description

Overview

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 Alpharetta, GA; Windsor, CT; or 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. A background in a Clinical Risk Management role is encouraged but we will consider qualified candidates, especially those with an oncology or cardiology background. This role is ideal for applicants looking to enter the insurance sector in a nurse consultant capacity.

The role includes responsibilities to use your knowledge and experience to project expected treatment costs based on ICD-9 / ICD-10 codes, current treatment plans, and other pertinent medical information.

Principal 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 individuals and communicate required Stop Loss cost analysis of current clinical conditions and future cost projections.
• Utilize provided clinical resources such as PredictDr., 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 collaborates closely with Underwriters to determine and evaluate potential risk and associated costs of projected treatments and care. We are a welcoming team of nurses who value diversity and inclusion as part of our winning culture. We encourage you to join us and contribute to our mission.

About You

You bring strong analytical and problem-solving expertise. Excellent interpersonal skills enable cross-functional collaboration. You can prioritize well and work independently with minimal supervision while handling multiple projects.

Additional Requirements

• Minimum of Associate or Bachelor's degree in nursing with at least 1 year of Stop Loss Nursing experience
• Active, up-to-date registered nurse (RN) license
• Demonstrated ability to produce work that is highly accurate with strong attention to detail
• Experience managing multiple projects and handling large volumes of work with deadlines
• Excellent written and verbal communication skills
• Computer proficiency, including strong typing, internet research, and proficiency with Microsoft Word, Office, and Excel

The estimated base salary range for this position is $84,000 to $140,000. Salary offers take into account factors such as location, role scope, qualifications, complexity, experience, education, and employer budget. Swiss Re uses a total compensation approach including base pay, incentives, and benefits when determining individual compensation.

About Swiss Re

Swiss Re is a leading provider of reinsurance, insurance, and other forms of insurance-based risk transfer. We work to make the world more resilient by anticipating and managing risks, from natural catastrophes and climate change to cybercrime. We employ more than 14,000 people worldwide. We foster an inclusive culture that values equal opportunities for all to thrive and develop professionally.

If you are an experienced professional returning to the workforce after a career break, we encourage you to apply for open positions that match your skills and experience.

We may use AI-powered tools to support the review and evaluation of applications for this position. These tools provide additional insights to our recruitment teams, but all hiring decisions are carefully reviewed and made by people. To learn more about how we use AI in recruitment and how we handle your personal data, please review our Data Privacy Statement before applying.

Keywords

Reference Code: 137700