Medical Risk Consultant - Remote

Symetra has an exciting opportunity to join our team 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 Underwriting purposes. This person will be aligned to support business that is west coast based.

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 within established timeframes to the Underwriters/RGM's for use 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
• Advise management and underwriters of potential claims involving significant risk as needed
• Work with Third Party Administrators (TPAs) and external Case Managers using 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 for internal and external customers:
  
  
  
  • Identify and support training opportunities for Claims, Underwriting, Sales, and TPA when 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 healthcare trends in assigned marketplace for potential solution implementation. Keep Underwriting and Sales appraised of any trends that pose risk
  
  
  
  
• Represent Symetra at Industry Conferences attending educational sessions to gain 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 Symetra

Here's what some of our employees have to say about why they work at Symetra:

"We're big enough to make an impact on the country, but small enough to care and know who you are and what you're contributing to the organization. All new ideas are welcome!" Stephanie F. - VP Customer Service & Operations

"The atmosphere at Symetra is truly different than at other companies. If you are looking for a company where your voice will matter and be heard, Symetra is the place for you."Sydney S. - Actuarial Associate II

What we offer you

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 our Symetra Benefits Overview

Compensation

Salary Range: $75,300 - 125,600 plus eligibility for annual bonus program

Your experience and skills

• 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

We empower inclusion

At Symetra, we aspire to be the most inclusive insurance company in the country. We're building a place where every employee feels valued, respected, and has opportunities to contribute.

Inclusion is about recognizing our assumptions, considering multiple perspective, and removing barriers. We accept and celebrate diverse experiences, identities, and perspectives, because lifting each other up fuels thought and builds a stronger, more innovative company. We invite you to learn more about our efforts here.

Creating a world where more people have access to financial freedom

Symetra is a national financial services company dedicated to helping people achieve their financial goals and feel confident about the future. In our daily work, we're guided by the principles of Value, Transparency and Sustainability. This means we provide products and services people need at a competitive price, we communicate clearly and openly so people understand what they're buying, and we design products-and operate our company-to stand the test of time. We're committed to showing up for our communities, lifting up our employees, and standing up for diversity, equity and inclusion (DEI). Join our team and help us create a world where more people have access to financial freedom.

For more information about our careers visit: https://symetra.eightfold.ai/careers

Work Authorization

Employer work visa sponsorship and support are not provided for this role. Applicants must be currently authorized to work in the United States at hire and must maintain authorization to work in the United States throughout their employment with our company.

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