If you're a nurse looking for a new challenge at a company where you can truly make an impact and help others, look no further. Symetra has an exciting opportunity to join our Medical Risk Management team as a Clinical Risk Nurse Consultant.
In this role you'll assist our Stop Loss Underwriters in evaluating potential medical treatment costs for individuals estimating claim risks for current and upcoming policy periods. The role can be located in one of the following locations Bellevue, WA; Enfield, CT; Atlanta, GA or Miami, FL.
About the Medical Risk Management team
This is a team that supports one another and works closely to ensure they're meeting the needs of the business and our customers. Here's how one team member, Lily describes why she enjoys working on this team
"I love my nurse peers because we truly function as one, helping each other without hesitation in all situations. We have diverse medical clinical backgrounds so we share our expertise with each other when needed. We are given support for any challenges with an open door management policy. It truly is a great place for a nurse."
What you'll do in the 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 to warn Underwriting and Sales of any risk impacting trends identified.
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 share industry news with internal contacts.
Project leadership and participation as needed.
Your education, experience and licensing
Bachelor's degree in Nursing or a related field
Licensed Registered Nurse (RN)
Case Manager Certification (CMC)
Clinical nursing = 4 or more years
Case management = 2 or more years
Health care or health insurance industry; stop loss or reinsurance preferred = 2 or more years
Preferred insurance industry education
Life Office Management Association (LOMA)
Health Insurance Association of America (HIAA)
International Claim Association (ICA)
Your skills and abilities
Ability to use varying resources to research diagnoses, treatments and average costs
Ability to work independently and in team environment
Strong customer service mentality
Ability to develop unified internal and external working relationships
Flexibility and agile with the ability to multi-task and quickly adapt to change
Strong prioritizing and organization skills
Excellent written and verbal communication skills
Strong computer proficiency (MS Word, Outlook, Excel and PowerPoint)
What we offer you
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.
Wellness program offering employees a variety of resources designed to assist you in reaching and maintaining your optimum health
Paid time away options to accommodate your needs and life's events, including vacation (our favorite), illness, caring for a family member, volunteering, the birth or adoption of a child, the loss of a family member and more
Ongoing learning and skills development through our college tuition assistance, professional education certification programs and more
Plan for your future with our 401(k) plan and take advantage of immediate vesting and company matching up to 6%
In a complex industry, we strive for clarity.Symetra is a dynamic and growing financial services company with 60 years of experience and customers nationwide. In our daily work delivering retirement, employee benefits, and life insurance products, we're guided by the principles of VALUE, TRANSPARENCY AND SUSTAINABILITY. That means we provide products and services people need at a competitive price, we communicate clearly and honestly so people understand what they're getting, and we build products that stand the test of time. We work hard and do what's right for our customers, communities and employees. Join our team and share in our success as we work toward becoming the next national player in our industry.