Medical Risk Consultant

Location

Boston, MA | United States

Job description

Atlanta, GA/Boston, MA/Indianapolis, IN/Plymouth Meeting, PA
Who are we? 

A strategic and trusted insurance partner, Berkshire Hathaway Specialty Insurance (BHSI), provides a broad range of commercial property, casualty and specialty insurance coverages and outstanding service to customers and brokers around the world. Part of Berkshire Hathaway’s insurance operations, we bring our solutions to market with our stellar brand name, top-rated balance sheet, and the expertise of our global team of professionals, who exude excellent capabilities and strong character.

We are a values-based organization where respect, integrity, excellence, collaboration, and passion define who we are and how we do business. We value diversity of backgrounds, experience, and perspectives and strive to foster an inclusive environment that enables all our team members to bring their best selves to work. We are one team committed to building a culture where every teammate has the opportunity to contribute and be recognized. Want to be part of the team building the finest property, casualty and specialty lines insurance company in the world?

Learn more about our unique cultureand history.

Job Opportunity: 

Berkshire Hathaway Specialty Insurance is seeking 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.

Duties & Responsibilities:

• Effectively explain complex clinical conditions to internal and external clients.
• Build strong relationships with internal (UW’s, Claims) and external clients (TPA’s, external CM’s) to communicate risk factors and projected cost of claims.
• Evaluate and assess both new business and renewal large claims/disclosure, clinical and claims data to identify known and potential risks and make potential cost recommendations to the stop loss underwriting team.
• Serve as the lead resource for underwriting in identifying potential large claims, and to project the expected cost of the potential claim.
• Quickly, thoroughly, and correctly assess a potential/actual claim situation to successfully influence risk decision makers, resulting in meaningful clinical and/or financial outcomes.
• Document and effectively communicate claim projections and rationale to stop loss underwriters.
• Develop a tracking system of claim cost projections and their effectiveness in reducing stop loss claims costs.

Qualifications, Skills and Experience:

• Bachelor’s Degree or equivalent combination of education and work experience.
• RN license required.
• Five years of relevant experience, preferably with stop loss carrier.
• Prior clinical experience preferred.
• Working knowledge of stop loss insurance policy and contract language.
• Verified knowledge of ESL Office, particularly the Underwriting, Claims and Policy Administration modules.
• Working knowledge of Microsoft Excel.
• Excellent oral, written, and interpersonal communication skills to achieve positive outcomes.
• Detail oriented.

BHSI Offers:

• A competitive package and exciting growth opportunities for career-oriented teammates.
• A dynamic, action oriented, and thoughtful environment centered on always doing the right thing for our customers, teammates and our other stakeholders.
• A purposely non-bureaucratic organization that embraces simplicity over complexity and emphasizes individual excellence in a team framework.

NOTE: Compensation will be commensurate with experience. This job description is not intended to be all-inclusive. Team Member may perform other related duties as negotiated to meet the ongoing needs of the organization.

Clicking apply will direct you to our recruiting module within ADP.

Job tags

Salary