Clinical Risk Manager

Clinical Risk Manager Swiss Re uses a hybrid work model requiring at least three days in the office each week. This position can be based near one of our Swiss Re offices, including Alpharetta, GA, Windsor, CT, Schaumburg, IL. We have an excellent opportunity for an experienced Clinical Risk Manager to join our team in Swiss Re's Accident & Health division! About the Role This position requires a strong clinical background in disease state management and case management experience. A background in a Clinical Risk Management position is encouraged, especially for candidates with an oncology or cardiology background. The role is ideal for applicants looking to enter the insurance sector in a nurse consultant role. In this position you will use your knowledge and experience to project expected treatment costs based on ICD 9 / ICD 10 codes, current treatment plan and other pertinent medical information. Principal Responsibilities Review medical conditions and respond with a cost analysis coordinated to the Stop Loss case characteristics, including the review and assessment of large claim reports, shock claim summary reports, trigger reports and large case management notes. Identify high risk associated with individuals and communicate required stop loss cost analysis of current clinical conditions and future cost projections. Utilize provided clinical resources such as Predict Dr., NCCN, NORD, and CDC. Supply and manage documentation with clinical summary and estimated cost of services for each individual identified as at risk. About the Team The Clinical Risk team brings value to Swiss Re working in close collaboration with Underwriters to determine and evaluate potential risk and associated costs of projected treatments and care. We are a welcoming team of nurses who are passionate about what they do. Diversity and Inclusion are a part of our winning culture, and we believe that individual performance contributes to the team’s success. About You You bring strong analytical and problem‑solving expertise. Your excellent interpersonal skills enable you to navigate cross‑functional collaboration and prioritize effectively while working independently with little direct supervision and handling multiple projects. Additional Requirements Minimum of Associate or Bachelor’s degree in nursing with at least 1 year of Stop Loss nursing experience . Must have an up‑to‑date registered nurse (RN) license. Able to demonstrate a track record of producing highly accurate work that reflects well on the organization. Proven experience managing multiple projects and handling large volumes of work under deadlines. Excellent written and verbal communication skills. Computer proficiency: strong typing skills and Internet research skills; clear understanding of Microsoft Word, Office, and Excel. Compensation The estimated base salary range for this position is $84,000 to $140,000, with compensation determined by factors such as job location, scope, qualifications, and experience. #J-18808-Ljbffr