Medical Office Operations Consultant

Found in: Jooble US O C2 - 2 weeks ago


Boston MA, United States Berkshire Hathaway Specialty Insurance Full time

A strategic and trusted insurance partner, Berkshire Hathaway Specialty Insurance (BHSI), provides a broad range of commercial property, casualty and specialty insurance coverages and outstanding service to customers and brokers around the world. Part of Berkshire Hathaway’s insurance operations, we bring our solutions to market with our stellar brand name, top-rated balance sheet, and the expertise of our global team of professionals, who exude excellent capabilities and strong character.
We value diversity of backgrounds, experience, and perspectives and strive to foster an inclusive environment that enables all our team members to bring their best selves to work. We are one team committed to building a culture where every teammate has the opportunity to contribute and be recognized. Want to be part of the team building the finest property, casualty and specialty lines insurance company in the world?
Berkshire Hathaway Specialty Insurance is seeking a medical risk consultant to join their medical stop loss team. The ideal candidate will utilize professional and clinical knowledge to assess risk. These activities will provide BHSI medical stop loss underwriters, claim auditors and external clients with appropriate clinical assessment of the anticipated care needs and potential costs of identified claimants.
Build strong relationships with internal (UW’s, Claims) and external clients (TPA’s, external CM’s) to communicate risk factors and projected cost of claims.
Evaluate and assess both new business and renewal large claims/disclosure, clinical and claims data to identify known and potential risks and make potential cost recommendations to the stop loss underwriting team
Serve as the lead resource for underwriting in identifying potential large claims, and to project the expected cost of the potential claim.
Quickly, thoroughly, and correctly assess a potential/actual claim situation to successfully influence risk decision makers, resulting in meaningful clinical and/or financial outcomes.
Document and effectively communicate claim projections and rationale to stop loss underwriters.
Develop a tracking system of claim cost projections and their effectiveness in reducing stop loss claims costs.
Bachelor’s Degree or equivalent combination of education and work experience
Working knowledge of stop loss insurance policy and contract language
Verified knowledge of ESL Office, particularly the Underwriting, Claims and Policy Administration modules.
Working knowledge of Microsoft Excel
A competitive package and exciting growth opportunities for career-oriented teammates



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