Stop Loss Registered Nurse

About the role

Works between underwriters, claims staff and third-party administrators to keep care appropriate and costs contained. Travel to clients or meetings comes to about a quarter of the time.

At a glance

What you will do

• Give underwriters cost estimates for new and renewal stop loss business
• Advise underwriters on catastrophic illness cases
• Review claim notices and excess claims to set reserves
• Oversee managed care between the third-party administrator and the company
• Research cost containment options and step in with the administrator

What they look for

• Active RN license in the state of hire and graduation from an accredited nursing school
• 10 years of experience, 5 clinical and 5 in medical management
• Knowledge of managed care, care delivery systems and catastrophic claim costs
• Ability to work alone, prioritize and decide with sound judgment
• Microsoft Office and word processing skills, with discretion on sensitive data

Nice to have

• Stop loss carrier experience and work with Medicare or Medicaid
• HMO reinsurance background and consulting experience with diverse clients
• Comfort reviewing large volumes of claims data and clinical information

Benefits

• Subsidized health, dental and vision plans, 401k match, life insurance and paid time off