Remote Clinical Underwriting Consultant

Favorably impact Stop Loss risk profile through early identification of potential high cost patients.

Profile Description:

• Serves as a subject matter expert in the evaluation of medical information to clarify diagnoses, evaluate the severity of medical conditions, and estimate the duration of treatment and expected future costs.
• Researches clinical conditions and provides analytical review of the medical and/or pharmacy data to formulate the history of events. Gathers and prepares preliminary clinical and medical analysis based on information from historical claims utilization data.
• Provides support to rate development through timely and accurate clinical and medical analysis to ascertain future risks and support the underwriting and risk management decision.
• Works collaboratively with the cost containment team to ensure a proper handoff of potential high cost patients. Prepares clinical and medical analysis based on employer group ...