Berkley Accident and Health is a risk management company that designs innovative solutions to address the unique challenges of each client. With our entrepreneurial culture and a strong emphasis on analytics, we can help employers better manage their risk. We offer 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 our nimble approach to risk – our ability to quickly understand, think through, and devise a plan that addresses each client’s challenges, coupled with the strong backing of a Fortune 500 company. Our parent company, W. R. Berkley Corporation, is one of the largest and best managed property/casualty insurers in the United States.
The company is an equal employment opportunity employer.
ResponsibilitiesWe have an opportunity for a Registered Nurse, Clinical Risk Manager to join our our Berkley Accident and Health team! You will perform medical risk analysis for Traditional/Captive business lines with the primary function of reviewing data to identify claimants and assess potential risks. This role requires that you have stop loss/self funding experience.
This position can be remote anywhere in the United States
We have a welcoming culture valuing our employees – we trademarked the phrase Everything Counts, Everyone Matters® to describe the Berkley commitment to our people and how we do business. We believe that every person in the organization is important and every accomplishment makes a difference in our results. Come join us!
Key functions include but are not limited to:
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 companyResearch medical conditions and treatment options using available resourcesDocument the medical review clearly, including an analysis of current clinical condition(s) and future annual claims projectionProvide clinical guidance to other team members as neededStrategize and prioritizes work load to achieve timelines and set goals for assigned workMake referrals to Clinical Cost Containment Services, and collaborate as needed to support their activitiesStay informed of medical and drug trends, sharing information with team members
Qualifications Associate or Bachelor's degree in Nursing; or a certificate in Nursing3+ years of clinical nursing experience2+ years of stop loss medical underwriting/risk management experienceAbility to interpret policies and procedures and communicate complex clinical topics effectivelyKnowledge of state and federal regulations related to underwritingOrganizational and analytical skills, 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 systemsAbility to establish effective working relationships with coworkers and internal/external customersStrong verbal, written, interpersonal communication and customer service skillsAbility to work independently with minimal direction and supervisionTravel requirements 5%
Additional Company Details We do not accept any unsolicited resumes from external recruiting firms.
The company offers a competitive compensation plan and robust benefits package for full time regular employees including:
• Base Salary Range: $100K - 110K
• This position is Bonus Eligible
• Benefits include: Health, dental, vision, dental, life, disability, wellness, paid time off, 401(k) and profit-sharing plans
The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. Sponsorship Details Sponsorship not Offered for this Role Job Description
Clinical Risk Manager 1 and 2 Revised
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