Medical Review RN – Stop Loss

Founded in 2003, Roundstone is not your typical insurance company. We’re on a mission to help employers save on healthcare benefits so they can put those savings towards bettering their businesses and taking care of their employees.

Role Description

As a Medical Review Nurse in Roundstone’s medical expense stop loss program, you will work with the claims staff to identify potentially large claims early in the process and use your expertise to manage the medical services. You’ll serve as a subject matter expert on newly approved and emerging treatments and help spot trends in patient care. Third party administrators and vendors will work closely with you on a regular basis. This position also works closely with the stop loss underwriters when preparing renewal and potential quotes for cost predictions and cost containment options. Review of amendments and informing underwriters if this addition to the plan will have a significant financial impact on the group. This is a great opportunity for someone with a nursing background to move into the insurance field.

Key Duties & Responsibilities:

• Ability to recognize potentially catastrophic diagnoses.
• Strong communicator, particularly regarding discussing and concisely summarizing medical conditions with non-medical professionals.
• Recognizes salient data to leverage in individual cases and trend for business stakeholders.
• Capable of identifying and completing tasks with minimal direct instruction. Tracks results and communicates status with stakeholders.
• Ability to multitask, prioritize, and find creative problem resolutions.
• Open collaborator with the ability to influence and lead indirectly.

Skills and Qualifications:

• Bachelor Degree in Nursing.
• Minimum 2 years medical coding, billing negotiation, or nursing experience.
• Experience reviewing/auditing medical records related to patient treatment, diagnosis, and provider billing to identify any medical and coding discrepancies.

Better Benefits:

We’re leaders in our industry, so naturally, we look out for our employees’ best interests with a robust benefits package. Roundstone employees are eligible for:

• Medical, dental and vision benefits
• Annual bonus
• Dependent care 100% match up to max allowable
• Parental leave
• Parental leave
• PTO beginning on Day 1
• Tuition reimbursement
• Healthy work/life balance
• Hybrid office schedule
• 401(k) plan with company match
• Employee Assistance Program
• On-site gym with personal trainer access
• Life insurance and short term disability insurance

More About Roundstone

Headquartered in Lakewood, Ohio, Roundstone is regularly recognized as a Northeast Ohio Top Workplace by the Plain Dealer and cleveland.com. We are especially proud to be recognized as a Top Workplace since this honor is determined by anonymous feedback from our own employees. Roundstone employees enjoy a supportive workplace where they are engaged, valued and regularly recognized for their hard work at monthly company meetings. Roundstone’s core values are evident every day and are shared with the community through the sponsorship of community events and outreach.

Our Core Values

• Live well: Be healthier and bring positive energy to all you do.
• Work smarter: Get things done, better.
• Own it: Accountability is your middle name. Be on time, do what you say, and finish what you start.
• Be intellectually curious: Always be learning. See opportunity everywhere and have a drive to know.

Culture and fit are integral to success and in an effort to achieve a better match both from a candidate's perspective and our organization, please take a minute, click on the link and take the really brief survey:

https://go.cultureindex.com/p/vdNOUHg4OcQTU

Don't meet every single requirement? Studies have shown that women and people of color are less likely to apply to jobs unless they meet every single qualification. At Roundstone Insurance we are dedicated to building a diverse, inclusive, and authentic workplace, so if you're excited about this role but your past experience doesn't align perfectly with every qualification in the job description, we encourage you to apply anyways. You may be just the right candidate for this or other roles.