Clinical Risk Manager II

Company Details

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.

This Position Can Either Be Fully Remote (if Not Within Commutable Distance To The Office) Or Based In One Of Our Offices

• Hamilton Square, NJ
• Marlborough, MA
• Harleysville, PA
• West Hartford, CT
  
  

Our offices offer a hybrid work schedule with 4 days in the office; and 1 day remote where it makes sense to do so.

The Company is an equal employment opportunity employer.

Responsibilities

As a Clinical Risk Manager, you'll perform medical risk analysis for our Traditional, Captive, and Managed Care business lines. The primary function is to review data to identify claimants and assess potential risks.

What You Can Expect

• Culture of innovation, teamwork, supportive colleagues and leaders willing to invest in talent
• Internal mobility opportunities
• Visibility to senior leaders and partnership with cross functional teams
• Opportunity to impact change
• Benefits – competitive compensation, paid time off, comprehensive wellness benefits and programs, employer funded health savings account, profit sharing, 401k, paid parental leave, employee stock purchase plan, tuition assistance and professional continuing education
  
  

We'll Count On You 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 company
• Researches medical conditions and treatment options using available resources
• Document the medical review clearly, including an analysis of current clinical condition(s) and future annual claims projection
• Provide clinical guidance to other team members as needed
• Strategize and prioritize work load 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, sharing information with team members
  
  

Qualifications

What you need to have:

• Bachelor’s Degree in Nursing or related clinical field, or equivalent combination of education and experience
• 3 years direct clinical experience, preferably in acute care
• 4 years experience in medical underwriting or risk management
• Knowledge of medical coding and terminology (AHIP certification a plus)
• Knowledge of state and federal regulations related to underwriting
• Ability to interpret policies and procedures and communicate complex clinical topics effectively
• Ability to exercise sound judgment, initiative and discretion in a mature and sensitive manner
• Proficiency using Microsoft Office (Word, Excel, Outlook) or comparable software, and ability to learn and use complex systems
• Travel requirements 5%
  
  

What Makes You Stand Out

• Organizational and analytical skills, a demonstrated ability to manage multiple tasks simultaneously
• 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
  
  

Additional Company Details

We do not accept any unsolicited resumes from external recruiting agencies or firms.

Benefits

The company offers a competitive compensation plan and robust benefits package for full time regular employees which for this role include:

• Base Salary Range: $100,000 to $115,000
• Eligible to participate in annual discretionary bonus
• Benefits: Health, Dental, Vision, 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