Provide medical risk analysis for stop loss underwriters on potential ongoing risk for new business cases and in-force renewals. Evaluate large claimants and predict ongoing future claim costs.

Experience and Qualifications:

*** Deep knowledge of stop loss product and comfort with medical terminology to identify catastrophic risk.

*** Skill in Microsoft Excel, Office and strong Internet research skills with ability to simultaneously use multiple systems when reviewing a large claimant.

*** Clinical experience, stop loss insurance, medical underwriting or claim experience considered.

Responsibilities

*** Provide individual medical risk analysis on large claimants for proposed stop loss business.

*** Review detailed large claim reports from a variety of sources including trigger reports, detailed individual claim reports, pending and denied reports, case management reports, and utilization reports.

*** Analyze medical procedure codes, medication J codes, and prescription drug reports to assist in predicting the future claim costs.

*** Research medical conditions and treatment options using resources including the internet, nursing, clinical resource tools.

*** Project future costs of care for those claimants who may exceed the Stop loss individual specific level.

*** Determine current treatment and cost of care based on the information received for review.

*** Utilize resources provided to evaluate shock claims.

*** Provide training to underwriters when applicable.

Fast paced and growth oriented organization offers a competitive compensation package, comprehensive health care plan, bonuses, 401(k) with company match, company vehicle, cell phone, generous vacation time, numerous professional development opportunities, and more!

For details contact Mason Ingling at:
(609) 584-9000 ext 239

Or submit resume online at:
http://dmc9.com/mpi/app.asp

Or email to:
1000034842_10007348@jobbank303.com

Please reference #38291102 when responding.

2+ years

New Jersey

$60,000.00

$130,000.00

Mason Ingling

(609) 584-9000 ext 239

1000034842_10007348@jobbank303.com

http://dmc9.com/mpi/app.asp

WE ARE AN EQUAL OPPORTUNITY EMPLOYER and our employment decisions are made without regard to race, color, religion, age, sex, national origin, handicap, disability or marital status. We reasonably accommodate individuals with handicaps, disabilities and bona fide religious beliefs. Jobs Career Position Hiring. CONSIDERED EXPERIENCE INCLUDES: http://najobbank.com www.najobbank.com Top 10 Job Site Top 10 Careers Site Clinical Risk Manager Health Insurance Nurse RN Clinical Risk Specialist Nurse Practitioner Family Nurse Physicians Assistant Medical Stop Loss Stop Loss Insurance Claims Registered Nurse Medical Insurance

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