Medical Risk Consultant – Remote

Job description

Symetra has an exciting opportunity to join our team as a Medical Risk Consultant! About the role: In this role you will evaluate stop loss claimant details on incumbent and prospective business to evaluate potential medical and prescription treatment plan(s) and associated costs to provide estimated risk for Underwriting purposes. What you will do: - Review policyholder data to identify claimants with catastrophic care needs and assess medical and claim information to calculate potential risk - Provide written claimant assessments within established timeframes to the Underwriters/RGM’s for use when establishing rates for new and renewal business - Review potential stop loss claim notices to identify case management and cost containment opportunities to reduce potential excess loss claim expenses - Advise management and underwriters of potential claims involving significant risk as needed - Work with Third Party Administrators (TPAs) and external Case Managers using medical and claims management resources to facilitate clinical and financial outcomes for claimants with complex and catastrophic medical conditions - Maintain current claimant clinical status, cost containment activiti...