Clinical Risk Manager, Medical Underwriting, C&F Stop Loss

Medical Risk Assessment & Clinical Evaluation:

• Review and analyze all data and documentation within existing systems and that provided by Underwriting.
• Identify clinical factors that may impact underwriting outcomes or financial exposure at a claimant and population health level for Underwriters to leverage in their rating of the group.
• Exercise independent clinical judgment to synthesize complex medical information into clear risk conclusions that support sound underwriting decisions.

Strategic Underwriting Partnership:

• Triage and prioritize requests for medical underwriting review based on business urgency, workload capacity, and alignment with underwriting and leadership priorities
• Act as a strategic partner to underwriting by applying evidence-based criteria and sound clinical judgment to evaluate complex clinical and claims data to identify, quantify, and advise on significant risks, directly influencing underwriting strategy and decisions.
• Consult with clients and teams on submitted data for MUW, program development, quality improvement, and claim issues.

Operational Excellence & Compliance:

• Support and explore new methods and processes to increase efficiency and achieve individual and organizational goals.
• Ensure compliance with all company policies, procedures, and service standards.
• Document all activities and outcomes accurately and promptly, keeping management informed of progress and potential issues.