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.

The company is an equal employment opportunity employer.

Responsibilities

We have an opportunity for a Clinical Risk Manager to join our Berkley Accident and Health team! You will perform medical risk analysis for Traditional, Captive, and Managed Care business lines.

The primary function is to review data to identify claimants and assess potential risks.

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 company
• Research 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
• Makes referrals to Clinical Cost Containment Services, and collaborate as needed to support their activities
• Stays informed of medical and drug trends, sharing information with team members

Qualifications

•  Bachelor's Degree in Nursing or related clinical field
• 3 years of clinical experience, preferably in acute or managed care
• 4 years in medical underwriting or risk management 
• Knowledge of medical coding and terminology
• AHIP certification a plus
• Travel requirement 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. 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