| Symetra is a dynamic and growing financial services company with 50 years of experience and customers nationwide. In our daily work delivering retirement, employee benefits, and life insurance products, we’re guided by the principles of VALUE, TRANSPARENCY AND SUSTAINABILITY. That means we provide products and services people need at a competitive price, we communicate clearly and honestly so people understand what they’re getting, and we build products that stand the test of time. We work hard and do what’s right for our customers, communities and employees. Join our team and share in our success as we work toward becoming the next national player in our industry. |
The Medical Risk Consultant is responsible for assisting Stop Loss Underwriters in evaluating potential medical treatment cost of individuals identified in new and renewal business underwriting process to provide estimated claim risk for current and upcoming policy periods. They also act as a resource to Policyholder's Third Party Administrator and Case Management Vendor with care and cost management oversight of potential stop loss claimants.
Review policyholder data to identify claimants with catastrophic care needs and assess medical & claims information available to calculate potential risk. Provide written claimant assessments within established deadlines to the Underwriters/RGM’s to utilize 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. Notify appropriate management and underwriters of potential claims involving significant risk. Work with Third Party Administrators (TPAs) and external Case Managers utilizing 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 activities and contact information in ESL.
Act as a resource to internal and external customers by: Identifying and supporting training opportunities for Claims, Underwriting, Sales, and TPA when knowledge gaps are identified. Providing clinical opinion from knowledge, experience and/or research to claims examiners and underwriters as requested or deemed appropriate. Assessing and recommending effective claim cost containment and managed care vendors including preferred provider networks in assigned geographical region for introduction to identify geographical healthcare trends in assigned geographic marketplace for potential solution implementation and to warn Underwriting and Sales of any risk impacting trends identified.
Represent Symetra at Industry Conferences attending educational sessions to gain awareness of new diagnoses, treatments, costs and industry trends. Maintain CE hours to meet State RN Licensure and CCM (or Industry) certification renewal requirements. Author educational articles to share industry news with internal contacts. Project leadership and participation as needed.