Job Description:
• Review and analyze clinical data to assess potential stop loss claim liabilities
• Provide cost projections on high-dollar claimants to support underwriting decisions
• Utilize case management techniques to ensure effective cost containment and management of high-risk claims
• Work closely with Third Party Administrators (TPAs), case managers, and internal teams to ensure effective communication and management of clinical information
• Maintain accurate and detailed documentation of clinical assessments, cost projections, and case management activities
• Identify high-risk individuals and communicate required stop loss cost analysis based on current clinical conditions and future cost projections
• Prepare and present reports on clinical risk assessments and cost projections to senior management
Requirements:
• At least 3 years of clinical experience
• Minimum of 1 year in stop loss nursing or clinical risk management
• Current and valid Registered Nurse (RN) license
• Strong analytical and problem-solving skills
• Proficiency in Microsoft Office Suite (Outlook, Word, Excel, PowerPoint, Copilot)
Benefits:
• Paid time off for company holidays, vacation, sick and personal days
• Paid parental leave
• Mental health services
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Apply Now