Clinical Consultant – Accident & Health

Job not on LinkedIn

🔥 8 minutes ago

🇺🇸 United States – Remote

💵 $80k - $130k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

👻 Ghost score 0%

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Skyward Specialty Insurance

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2007

🏗️ Construction

💼 Consulting

🏥 Healthcare

💰 $177.3M Post-IPO Secondary - Skyward Specialty on 2024-05

Construction • Consulting • Healthcare

Skyward Specialty Insurance is a Houston-based specialty insurance group that provides tailored risk solutions across niche and complex markets. The company offers a range of specialty insurance products including transactional Excess & Surplus (E&S), professional lines, medical stop-loss, surety, captives, programs, global property, agriculture & credit (re)insurance, and risk consulting. Skyward works primarily with brokers and agents, leverages technology (including e-surety capabilities) to deliver innovative underwriting and claims services, and focuses on high-complexity, non-standard risks and scalable specialty solutions.

📋 Description

• Ensure effective risk management through reviews and assessment of new business and renewal large claims/disclosures • Assist underwriters in evaluating clinical and claims data and provide reporting of analysis findings, observations, and recommendations • Explain complex clinical conditions to the team • Develop and maintain client, TPA, and vendor relationships • Consult with clients and TPAs on case management, alternative levels of care, program development, quality improvement, claims issues, and educational needs • Work with claim teams to develop cost mitigation strategies and achieve effective clinical and financial outcomes • Assist with medical necessity determinations and claim audits • Perform transplant and complex/catastrophic care reviews, including treatment-plan medical necessity and experimental-treatment reviews • Consult on high-cost claims and implement clinical risk-management strategies • Determine the need for extra-contractual agreements or specialty resources and act as liaison until claim completion • Serve as a risk-management resource for claims and underwriting related to Accident & Health claims • Establish and adjust reserve recommendations and review them monthly • Communicate risk factors, resolve complex inquiries, and develop continuous-improvement recommendations

🎯 Requirements

• 5+ years of clinical and case management experience • RN license required • CCM preferred • Bachelor's degree preferred • Stop loss and reinsurance experience preferred • Excellent written and oral communication skills • Ability to multi-task and prioritize • Team oriented yet able to work independently • Ability to build and maintain strong professional relationships • Proficiency with Excel, Word and spreadsheet analysis

🏖️ Benefits

• Health and welfare benefits • Tuition and professional certification assistance • 401k savings • Elective participation in the Employee Stock Purchase Program • Paid time off • Paid holidays • Child bonding leave • Other employee assistance • Performance-based incentives may be available