Medical Risk Consultant

Symetra has an exciting opportunity to join our team as a Medical Risk Consultant!

About the role

Responsible for assisting Stop Loss Underwriters in evaluating potential medical treatment cost of individuals identified in new and renewal business underwriting process to provide estimated claim risk for current and upcoming policy periods. Responsible for assisting as a resource Policyholder's Third-Party Administrator and Case Management Vendor with care and cost management oversight of potential stop loss claimants. May have significant, specialized responsibilities related to cost containment coordination.

What you'll do in this role

• Review policyholder data to identify claimants with catastrophic care needs and assess medical & claims information available to calculate potential risk. Provide written claimant assessments within established deadlines to the Underwriters/RGM's to utilize when 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. Notify appropriate management and underwriters of potential claims involving significant risk.
• Work with Third Party Administrators (TPAs) and external Case Managers utilizing medical and claims management resources to facilitate clinical and financial outcomes for claimants with complex and catastrophic medical conditions. Maintain current claimant clinical status, cost containment activities and contact information in ESL.
  
  
• Act as a resource to internal and external customers by identifying and supporting training opportunities for Claims, Underwriting, Sales, and TPA when knowledge gaps are identified.
• Providing clinical opinion from knowledge, experience and/or research to claims examiners and underwriters as requested or deemed appropriate.
• Assessing and recommending effective claim cost containment and managed care vendors including preferred provider networks in assigned geographical region for introduction to
• Identify geographical healthcare trends in assigned geographic marketplace for potential solution implementation and warn Underwriting and Sales of any risk impacting trends identified.
• Maintain CE hours to meet State RN Licensure and CCM (or Industry) certification renewal requirements. Author educational articles to share industry news with internal contacts.
• Project leadership and participation as needed. Maintain awareness of new diagnoses, treatments, costs and industry trends.
  
  

What we offer you

"Just do it! Even if you feel like you may not be 100% qualified, apply. Sometimes we see potential in others that they cannot see in themselves. You may be overqualified, or you may be the "something special" we are looking for to bring a unique, fresh approach to our company." - Ruby S., Associate EDX Analyst

If you want to work for a company that is always considering its employees while working towards sustainable growth this is that company. Within Symetra, there is always innovation, empowerment, and growth opportunities, all while providing us with a great work/life balance and incredible benefits for a very reasonable cost!" - Cindy J. G., Sr. Product Owner

"Symetra is truly a great place to work. The positive work climate, strong sense of team, and the resources available make it feel like one cohesive family. What stands out most to me is the company's deep commitment to diversity, equity, and inclusion-it's not just a statement, it's an active and ongoing priority that's felt throughout the organization." -Charlotte G., Sr. Underwriter - Consultant Stop Loss

Benefits and Perks

We don't take a "one-size-fits-all" approach when it comes to our employees. Our programs are designed to make your life better 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, flex days and ten paid holidays
• Give back to your community and double your impact through our company matching
• Want more details? Check out ourSymetra Benefits Overview

Compensation

Salary Range: $77,600- $129,400 plus eligibility for annual bonus program

Who you are:

• Registered Nurse license required
• Associate's Degree required. Bachelor's degree preferred.
• 4+ years clinical nurse experience and two or more years case management experience preferred
• 2+ years' experience in health care or health insurance industry; stop loss or reinsurance preferred
• Case Manager Certification (CCM) and Insurance industry education (LOMA, HIAA, ICA, etc.) preferred
• Comfortable using a variety of resources to research diagnoses, treatments, and average costs
• Strong proficiency with the Microsoft Office Suite especially Excel
• Works productively independently and as part of team
• Phenomenal customer service and interpersonal skills
• Great at relationship building with internal and external partners
• Adept at prioritization, organization, and time management
• Excellent written and verbal communication skills
• Thrives in a fast-paced environment
• High attention to detail