Clinical Risk Manager

Position Summary

We are seeking a highly skilled and experienced Stop Loss Clinical Risk Manager to join our team. The ideal candidate will have a strong clinical background and demonstrated expertise in evaluating and managing stop loss claims. This role includes analyzing clinical data, assessing potential risks, recommending mitigation strategies to key stakeholders, and providing cost projections that support our sales, underwriting, claims, and risk management services.

Job Description

Key Responsibilities:

• Clinical Data Analysis: Review and analyze clinical data to assess potential stop loss claim liabilities.
• Cost Projections: Provide cost projections on high-dollar claimants to support underwriting decisions.
• Case Management Oversight: Utilize case management techniques to ensure effective cost containment and management of high-risk claims.
• Collaboration: Work closely with Third Party Administrators (TPAs), ...