Clinical Risk Manager - Temporary

Berkley Accident and Health is a risk management company that designs innovative solutions to address the unique challenges of each client. With an entrepreneurial culture and a strong emphasis on analytics, the company helps employers better manage their risk. It offers a broad range of products, including employer stop loss, benefit captives, provider stop loss, HMO reinsurance, and specialty accident. The key to Berkley’s success is a nimble approach to risk—quickly understanding, thinking through, and devising plans that address each client’s challenges, backed by the strength of W. R. Berkley Corporation, a Fortune 500 company.

Responsibilities

• Review detailed claim reports from a variety of sources to predict current and future claim costs.
• Apply guidelines as appropriate to meet the goals of the company.
• Research medical conditions and treatment options using available resources.
• Document medical reviews clearly, including analysis of current clinical condition(s) and future annual claims projection.
• Provide clinical guidance to other team members as needed.
• Strategize and prioritize workload to achieve timelines and set goals for assigned work.
• Make referrals to Clinical Cost Containment Services and collaborate as needed to support their activities.
• Stay informed of medical and drug trends and share information with team members.

Requirements

• Organizational and analytical skills with a demonstrated ability to manage multiple tasks simultaneously.
• Ability to exercise sound judgment, initiative, and discretion in a mature and sensitive manner.
• Computer skills including experience using Microsoft Office (Word, Excel, Outlook) or comparable software, and ability to learn and use complex systems.
• Ability to establish effective working relationships with coworkers and internal/external customers.
• Strong verbal, written, interpersonal communication, and customer service skills.
• Ability to work independently with minimal direction and supervision.
• Ability to interpret policies and procedures and communicate complex clinical topics effectively.
• Approximately 5% travel.
• Knowledge of state and federal regulations related to underwriting.

Qualifications

Clinical Risk Manager I – Preferably an Associate or Bachelor’s Degree in Nursing or related clinical field, three years direct clinical experience (preferably in acute or managed care), and two years’ experience in medical underwriting or risk management, or an equivalent combination of education and experience.

Clinical Risk Manager II – Preferably a Bachelor’s Degree in Nursing or related clinical field, three years direct clinical experience (preferably in acute care), and four years’ experience in medical underwriting or risk management, knowledge of medical coding and terminology (AHIP certification a plus), or an equivalent combination of education and experience.

Schedule

Temporary, part-time role (up to 200 hours, approximately 20 hours per week from September through December).

Sponsorship is not offered for this role. We do not accept unsolicited resumes from third-party recruiting agencies or firms.