Stop Loss Clinical Consultant

4 weeks ago

Beverly Hills, California, United States Strategic Risk Solutions Full time

Strategic Risk Solutions Inc. (SRS), the world's largest independent insurance company manager, is growing and looking for a highly motived Stop Loss Clinical Consultant with a current RN License to join Alpha Isle Services – our division that administers medical stop loss claims.
This remote position will utilize nursing knowledge and analytical skills to assess potential medical conditions and treatments for claimants under stop-loss insurance policies.
Responsibilities and Duties

  • Analyze medical records and claims data to identify high-risk individuals and potential stop-loss claims
  • Evaluate the medical necessity and appropriateness of care delivered to high-risk patients
  • Collaborate with claims auditor, underwriter, vendor to discuss and place appropriate cost containment measures
  • Serve as a subject matter expert on newly approved and emerging treatments and help spot trends in patient care
  • Identify opportunities for cost containment and case management for high-risk claims
  • Communicate complex medical information to non-clinical audiences in a clear and concise manner
  • Work with Third Party Administrators (TPAs) and external Case Managers utilizing medical and claims management resources to facilitate clinical and financial outcomes for claimants with complex and catastrophic medical condition

Attributes and Skills

  • Bachelor's degree in nursing or a related field (preferred)
  • Minimum of 2-4 years of clinical nursing experience
  • Experience in case management or utilization review a plus
  • Strong analytical and problem-solving skills
  • Excellent communication and interpersonal skills, both written and verbal
  • Proficient in Microsoft Office Suite, including Excel
  • Ability to set claim reserves for designated clients based upon clinical data
  • Ability to work independently and in team environment


About Strategic Risk Solutions
SRS is the world's largest independent insurance company manager. With over 25 years of experience, SRS provides management and consulting services to a wide range of insurance company entities, from single parent captives to complex commercial insurers and reinsurers. SRS has operations in the United States, Canada, Europe, Barbados, Bermuda, Cayman Islands, Latin America, and South Africa.
AIS is an industry leading medical stop loss claims administrator with more than 100 years of combined self-funding claims experience. For MGUs, insurance carriers, self-insured employers and captives AIS services provide assurance that claims are managed correctly, payments are accurate and that the cost of large individual claims and aggregate claims are mitigated.
Offering a competitive salary, bonus plan, and a generous benefits package, SRS strives to provide every employee with opportunities for rewarding growth and advancement in an environment of genuine equity and inclusion. The pace is fast and demanding, and SRS's dedication to its people has established a company-wide network of colleagues committed to each other's, as well as the Company's, success.
EOE
For more information on SRS, please visit
For more information on AIS, please visit

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