If you're a nurse looking for a new challenge at a company where you can truly make an impact and help others, look no further. Symetra has an exciting opportunity to join our Medical Risk Management team as a Clinical Risk Nurse Consultant.

In this role you'll assist our Stop Loss Underwriters in evaluating potential medical treatment costs for individuals estimating claim risks for current and upcoming policy periods.  The role can be located in one of the following locations Bellevue, WA; Enfield, CT; Atlanta, GA or Miami, FL.

About the Medical Risk Management team

This is a team that supports one another and works closely to ensure they're meeting the needs of the business and our customers. Here's how one team member, Lily describes why she enjoys working on this team

"I love my nurse peers because we truly function as one, helping each other without hesitation in all situations. We have diverse medical clinical backgrounds so we share our expertise with each other when needed. We are given support for any challenges with an open door management policy. It truly is a great place for a nurse."

What you'll do in the role

• 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.