Medical Risk Consultant – Remote

Medical Risk Consultant position available at Symetra, a national financial services company. The role involves evaluating stop loss claimant details and providing estimated risk for Underwriting purposes. The job requires a Registered Nurse license, Associate’s Degree, and 3+ years of clinical nurse experience.

Requirements

• Review policyholder data to identify claimants with catastrophic care needs
• Assess medical and claim information to calculate potential risk
• Provide written claimant assessments within established timeframes
• Work with Third Party Administrators (TPAs) and external Case Managers
• Maintain current claimant clinical status, cost containment activities, and contact information
• Act as a resource for internal and external customers
• Identify and support training opportunities for Claims, Underwriting, Sales, and TPA
• Provide clinical opinion from knowledge, experience, and/or research
• Assess and recommend effective claim cost containment and managed care vendors
• Represent Symetra at Industry Conferences
• 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

Benefits

• Flexible full-time or hybrid telecommuting arrangements
• 401(k) plan with immediate vesting and company matching up to 6%
• Paid time away including vacation and sick time, flex days, and ten paid holidays
• Company matching for giving back to the community
• Annual bonus program