Medical Risk Consultant – Remote

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 activities and contact information in ESL
• Act as a resource for internal and external customers:
  • Identify and support training opportunities for Claims, Underwriting, Sales, and TPA when knowledge gaps are identified
  • Provide clinical opinion from knowledge, experience and/or research to claims examiners and underwriters as needed
  • Assess and recommend effective claim cost containment and managed care vendors including preferred provider networks in assigned geographical region
  • Identify geographical healthcare trends in assigned marketplace for potential solution implementation. Keep Underwriting and Sales appraised of any trends that pose risk
• 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 provide industry updates to internal contacts
• Project leadership and participation as needed

Why Work at Symetra

Here’s what some of our employees have to say about why they work at Symetra: 

"If given an opportunity to work for this amazing company-say yes!  You will not be disappointed." - Rebecca A., Sr. Medical Risk Consultant

“If you’re 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’ve never been happier in my career!” - Gina B., Medical Risk Manager

What we offer you

Benefits and Perks

We don’t 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.

• Flexible full-time or hybrid telecommuting arrangements
• Plan for your future with our 401(k) plan and take advantage of immediate vesting and company matching up to 6%
• Paid time away including vacation and sick time, flex days and ten paid holidays
• Give back to your community and double your impact through our company matching
• Want more details? Check out our Symetra Benefits Overview

Compensation

Salary Range: $79,900 - $133,200 plus eligibility for annual bonus program