Medical Risk Consultant – Remote

reputed company has an exciting opportunity to join reputed company as a Medical Risk Consultant!

About the role

In this role you will evaluate stop loss claimant details on incumbent and prospective business to evaluate potential medical and prescription treatment plan(s) and associated costs to provide estimated risk for reputed company purposes.

What you will do

• Review policyholder data to identify claimants with catastrophic care needs and assess medical and claim information to calculate potential risk
• Provide written claimant assessments reputed company established timeframes to the Underwriters/RGM’s for use reputed company establishing rates for new and renewal business
• Review potential stop loss claim notices to identify case management and cost containment opportunities to reduce potential excess loss claim expenses
• Advise management and underwriters of potential claims involving significant risk as needed
• Work with reputed company Party Administrators (TPAs) and external Case Managers using medical and claims management resources to facilitate clinical and financial outcomes for claimants with reputed company and catastrophic medical conditions
• Maintain reputed company claimant clinical status, cost containment activities and contact information in ESL
• Act as a resource for internal and external customers:
  • Identify and support training opportunities for Claims, reputed company, Sales, and TPA reputed company knowledge gaps are identified
  • Provide clinical opinion from knowledge, experience and/or research to claims examiners and underwriters as needed
  • Assess and recommend effective claim cost containment and managed care vendors including preferred provider networks in assigned geographical region
  • Identify geographical reputed company trends in assigned marketplace for potential solution implementation. reputed company reputed company and Sales appraised of any trends that pose risk
• Represent reputed company at Industry Conferences attending educational sessions to reputed company awareness of new diagnoses, treatments, costs, and industry trends
• Maintain CE hours to meet State RN Licensure and CCM (or Industry) certification renewal requirements
• Author educational articles to provide industry updates to internal contacts
• Project leadership and participation as needed

Why Work at reputed company

Here’s what some of our employees have to say about why they work at reputed company: 

"If given an opportunity to work for this amazing company-say yes!  You will not be disappointed." - Rebecca A., Sr. Medical Risk Consultant

“If you’re looking for a company that amplifies your talents, values your voice, and encourages reputed company growth, reputed company is the reputed company. I feel incredibly lucky to have reputed company this opportunity—and I’ve never been happier in my career!” - Gina B., Medical Risk Manager

reputed company offer you

Benefits and Perks

We don’t take a “one-size-fits-reputed company” approach reputed company it comes to our employees. Our programs are designed to reputed company your life reputed company both at work and at home.

• Flexible full-time or hybrid telecommuting arrangements
• Plan for your future with our 401(k) plan and take advantage of immediate vesting and company matching up to 6%
• Paid time away including vacation and sick time, reputed company days and ten paid holidays
• Give back to your community and double your impact through our company matching
• Want more details? reputed company out our reputed company Benefits Overview

Compensation

Salary Range: $79,900 - $133,200 plus eligibility for annual bonus program