Remote Clinical Underwriting Consultant

Profile Summary:

Favorably impact Stop Loss risk profile through early identification of potential high cost patients.

Profile Description:

• Serves as a subject matter expert in the evaluation of medical information to clarify

diagnoses, evaluate the severity of medical conditions, and estimate the duration of

treatment and expected future costs.

• Researches clinical conditions and provides analytical review of the medical and/or

pharmacy data to formulate the history of events. Gathers and prepares preliminary clinical

and medical analysis based on information from historical claims utilization data.

• Provide support to rate development through timely and accurate clinical and medical

analysis to ascertain future risks and support the underwriting and risk management

decision

• Works collaboratively with the cost containment team ensure a proper hand off of potential

high cost patients. Prepares clinical and medical analysis based on employer group

utilization and claims data and coordinates with the appropriate Cost Containment specialty

teams to address these identified risks.

Knowledge & Experience:

• Bachelor’s degree - current unrestricted RN license, or equivalent clinical degree

• Minimum 5 years of clinical experience

• Minimum 2 years insurance experience

• Analytical and problem solving skills

• Excellent interpersonal and negotiation skills to act as a company representative

• Experience in Microsoft Office products