Medical Risk Consultant Remote

Symetra has an exciting opportunity to join our team as a Medical Risk Consultant!\n\nAbout the role\n\nIn 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. \n\nWhat you will do\n\n * Review policyholder data to identify claimants with catastrophic care needs and assess medical and claim information to calculate potential risk\n * Provide written claimant assessments within established timeframes to the Underwriters/RGM\u0027s for use when establishing rates for new and renewal business\n * Review potential stop loss claim notices to identify case management and cost containment opportunities to reduce potential excess loss claim expenses\n * Advise management and underwriters of potential claims involving significant risk as needed\n * 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\n * Maintain current claimant clinical status, cost containment activities and contact information in ESL\n * Act as a resource for internal and external customers: \n * Identify and support training opportunities for Claims, Underwriting, Sales, and TPA when knowledge gaps are identified\n * Provide clinical opinion from knowledge, experience and/or research to claims examiners and underwriters as needed \n * Assess and recommend effective claim cost containment and managed care vendors including preferred provider networks in assigned geographical region \n * Identify geographical healthcare trends in assigned marketplace for potential solution implementation. Keep Underwriting and Sales appraised of any trends that pose risk\n * Represent Symetra at Industry Conferences attending educational sessions to gain awareness of new diagnoses, treatments, costs, and industry trends\n * Maintain CE hours to meet State RN Licensure and CCM (or Industry) certification renewal requirements\n * Author educational articles to provide industry updates to internal contacts\n * Project leadership and participation as needed\n\n\n\nWhy Work at Symetra\n\nHere\u0027s what some of our employees have to say about why they work at Symetra: \n\n\"If given an opportunity to work for this amazing company-say yes! You will not be disappointed.\" - Rebecca A., Sr. Medical Risk Consultant\n\n \n\n\"If you\u0027re looking for a company that amplifies your talents, values your voice, and encourages continuous growth, Symetra is the place. I feel incredibly lucky to have found this opportunity--and I\u0027ve never been happier in my career!\" \\- Gina B., Medical Risk Manager\n\nWhat we offer you\n\nBenefits and Perks\n\nWe don\u0027t take a \"one-size-fits-all\" approach when it comes to our employees. Our programs are designed to make your life better both at work and at home.\n\n * Flexible full-time or hybrid telecommuting arrangements\n * Plan for your future with our 401(k) plan and take advantage of immediate vesting and company matching up to 6%\n * Paid time away including vacation and sick time, flex days and ten paid holidays\n * Give back to your community and double your impact through our company matching \n * Want more details? Check out our Symetra Benefits Overview\n\n\n\nCompensation\n\nSalary Range: $79,900 - $133,200 plus eligibility for annual bonus program \n\nWho You Are\n\n * Registered Nurse license required \n * Associate\u0027s Degree required. Bachelor\u0027s degree preferred. \n * 3+ years clinical nurse experience and two or more years case management experience preferred\n * 2+ years\u0027 experience in health care or health insurance industry; stop loss or reinsurance preferred\n * Case Manager Certification (CCM) and Insurance industry education (LOMA, HIAA, ICA, etc.) a plus \n * Comfortable using a variety of resources to research diagnoses, treatments, and average costs\n * Strong proficiency with the Microsoft Office Suite especially Excel\n * Willingness to learn and leverage AI for workplace efficiency \n * Works productively independently and as part of team \n * Phenomenal customer service and interpersonal skills\n * Great at relationship building with internal and external partners \n * Adept at prioritization, organization, and time management \n * Excellent written and verbal communication skills\n * Thrives in a fast\u2011paced environment, with strong attention to detail and the ability to remain flexible and effective while managing multiple competing priorities.\n\nWe empower inclusion \nAt Symetra, we aspire to be the most inclusive insurance company in the country. We\u0027re building a place where every employee feels valued, respected, and has opportunities to contribute.\n\nInclusion is about recognizing our assumptions, considering multiple perspective, and removing barriers. We accept and celebrate diverse experiences, identities, and perspectives, because lifting each other up fuels thought and builds a stronger, more innovative company. We invite you to learn more about our efforts here.\n\n \n\nCreating a world where more people have access to financial freedom \nSymetra is a national financial services company dedicated to helping people achieve their financial goals and feel confident about the future. In our daily work, we\u0027re guided by the principles of Value, Transparency and Sustainability. This means we provide products and services people need at a competitive price, we communicate clearly and openly so people understand what they\u0027re buying, and we design products--and operate our company--to stand the test of time. We\u0027re committed to showing up for our communities, lifting up our employees, and standing up for diversity, equity and inclusion (DEI). Join our team and help us create a world where more people have access to financial freedom.\n\nFor more information about our careers visit: https://symetra.eightfold.ai/careers\n\n \n\nWork Authorization \nEmployer work visa sponsorship and support are not provided for this role. Applicants must be currently authorized to work in the United States at hire and must maintain authorization to work in the United States throughout their employment with our company.\n\n \n\nPlease review Symetra\u0027s Remote Network Minimum Requirements:\n\nAs a remote-first organization committed to providing a positive experience for both employees and customers, Symetra has the following standards for employees\u0027 internet connection:\n\n * Minimum Internet Speed:100 Mbps download and 20 Mbps upload, in alignment with the FCC\u0027s definition of \"broadband.\"\n * Internet Type:Fiber, Cable (e.g., Comcast, Spectrum), or DSL.\n * Not Permissible:Satellite (e.g., Starlink), cellular broadband (hotspot or otherwise), any other wireless technology, or wired dial-up.\n\n\n\nWhen applying to jobs at Symetra you\u0027ll be asked to test your internet speed and confirm that your internet connection meets or exceeds Symetra\u0027s standard as outlined above.\n\n \n\nIdentity Verification \n\nSymetra is committed to fair and secure hiring practices. For all roles, candidates will be required (after the initial phone screen) to be on video for all interviews. Symetra will take affirmative steps at key points in the process to verify that a candidate is not seeking employment fraudulently, e.g. through use of a false identity.\n\n \n\nFailure to comply with verification procedures may result in:\n\n * Disqualification from the recruitment process\n * Withdrawal of a job offer\n * Termination of employment and other criminal and/or civil remedies, if fraud is discovered\n\n\n