Medical Risk Consultant

You desire impactful work.
 

You’re RGA ready

RGA is a purpose-driven organization working to solve today’s challenges through innovation and collaboration. A Fortune 500 Company and listed among its World’s Most Admired Companies, we’re the only global reinsurance company to focus primarily on life- and health-related solutions. Join our multinational team of intelligent, motivated, and collaborative people, and help us make financial protection accessible to all.

A Brief Overview

The Medical Risk Consultant provide high quality case management and claims management consulting, including identification, assessment and management of high cost cases. Establishes reserves and ensures cost effective claims management. Promote client satisfaction and retention.

What you will do

• Ensure cost effective case management consultation services for high cost cases. Consult with clients on case management issues, alternative levels of care, program development, quality improvement and educational needs.

• Ensure cost effective reinsurance claims management. Consult with clients on high cost claims management strategies. Establish reserves, authorize claim payments, assist with audits, determine need for extra contractual agreements, and monitor clients’ claims activity.

• Report industry trends and assist with care and cost management strategies to reduce claim costs for clients and RGA.

• Work with RGA underwriting, account management and claims staff to improve service to customers and manage the customer relationship.

• Under limited supervision, communicate, market, and educate senior and middle management of current and prospective clients and brokers regarding program services available. Present appropriate information to prospective customers in sales presentations.

• Assist in the underwriting process with regard to evaluation of claims experience, future risk, and clients’ case and claims management capabilities.

• Audit/review clients’ case management and claims management practices on a regular basis. Perform Operational Review (in-depth audit and formal report) of clients’ internal case management programs.

• Review reinsurance treaty (contract) wording for understanding/administrative interpretation; evaluate clients’ current and future claims trends and provide recommendations to improve contract clarity.

• Assist with planning and hosting educational events including bi-monthly teleconferences.

Qualifications

• Bachelor’s Degree in Arts/Sciences (BA/BS) in Nursing/related field, with 5-7 years of clinical experience Required or

• Associate’s Degree (AA) or Diploma Degree with 7-10 years of experience Required

• 4+ Years case management experience Required

• Knowledge and expertise in health care systems and practices Required

• Flexibility, takes initiative, and demonstrates accountability Required

• Intermediate oral and written communication skills demonstrating ability to share and impart knowledge Required

• Quickly adapts to new methods, works under tight deadlines and stressful conditions Required

• Intermediate level of investigative, analytical, math aptitude and problem solving skills Required

• Intermediate presentation skills Required

• Sets goals and handles multiple tasks, clients, and projects simultaneously; Ability to appropriately balance priorities, deadlines, and deliverables Required

• Works well within a team environment and participates in department/team projects Required

• Balances detail with departmental goals/objectives Required

• Fosters customer service as needed Required

• Managed Care experience (either hospital or HMO/health insurance company). Preferred

• Cost Containment Experience (TPA, MGU, health plan) Preferred

• Certified Case Manager Preferred

• RN - Registered Nurse - State Licensure and/or Compact State Licensure and/or current CRRN, CIRS, CCM or CRC certification Required

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What you can expect from RGA:

• Gain valuable knowledge from and experience with diverse, caring colleagues around the world.

• Enjoy a respectful, welcoming environment that fosters individuality and encourages pioneering thought.

• Join the bright and creative minds of RGA, and experience vast, endless career potential.

Compensation Range:

$123,500.00 - $184,050.00 Annual

Base pay varies depending on job-related knowledge, skills, experience and market location