Berkley Accident and Health is a risk management company that designs innovative solutions to address the unique challenges of each client. With our entrepreneurial culture and a strong emphasis on analytics, we can help employers better manage their risk. We offer a broad range of products, including employer stop loss, benefit captives, provider stop loss, HMO reinsurance, and specialty accident. The key to Berkley’s success is our nimble approach to risk – our ability to quickly understand, think through, and devise a plan that addresses each client’s challenges, coupled with the strong backing of a Fortune 500 company. Our parent company, W. R. Berkley Corporation, is one of the largest and best managed property/casualty insurers in the United States.

 

The company is an equal employment opportunity employer.

We have an opportunity for a Registered Nurse, Clinical Risk Manager to join our our Berkley Accident and Health team! You will perform medical risk analysis for Traditional/Captive business lines with the primary function of reviewing data to identify claimants and assess potential risks. This role requires that you have stop loss/self funding experience.

 

This position can be remote anywhere in the United States 

 

We have a welcoming culture valuing our employees – we trademarked the phrase Everything Counts, Everyone Matters® to describe the Berkley commitment to our people and how we do business. We believe that every person in the organization is important and every accomplishment makes a difference in our results. Come join us! 

 

Key functions include but are not limited to:

• Review detailed claim reports from a variety of sources to predict current and future claim costs 
• Apply guidelines as appropriate to meet the goals of the company
• Research medical conditions and treatment options using available resources
• Document the medical review clearly, including an analysis of current clinical condition(s) and future annual claims projection
• Provide clinical guidance to other team members as needed
• Strategize and prioritizes work load to achieve timelines and set goals for assigned work
• Make referrals to Clinical Cost Containment Services, and collaborate as needed to support their activities
• Stay informed of medical and drug trends, sharing information with team members

 

 

 

• Associate or Bachelor's degree in Nursing; or a certificate in Nursing
• 3+ years of clinical nursing experience
• 2+ years of stop loss medical underwriting/risk management experience
• Ability to interpret policies and procedures and communicate complex clinical topics effectively
• Knowledge of state and federal regulations related to underwriting
• Organizational and analytical skills, a demonstrated ability to manage multiple tasks simultaneously.
• Ability to exercise sound judgment, initiative and discretion in a mature and sensitive manner.
• Computer skills including experience using Microsoft Office (Word, Excel, Outlook) or comparable software, and ability to learn and use complex systems
• Ability to establish effective working relationships with coworkers and internal/external customers
• Strong verbal, written, interpersonal communication and customer service skills
• Ability to work independently with minimal direction and supervision
• Travel requirements 5%

 

 

We do not accept any unsolicited resumes from external recruiting firms.

The company offers a competitive compensation plan and robust benefits package for full time regular employees including:
• Base Salary Range: $100K - 110K
• This position is Bonus Eligible
• Benefits include: Health, dental, vision, dental, life, disability, wellness, paid time off, 401(k) and profit-sharing plans

The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment.

Sponsorship not Offered for this Role

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