Insurance Risk Analyst

2 weeks ago

Miami, Florida, United States CareMax Inc Full time
Position Overview

Company Background:

CareMax Inc. is dedicated to delivering exceptional healthcare services with a focus on compassion and respect for our patients. Our mission is to enhance the quality of life for seniors through comprehensive medical care and support. We invite you to join our team and contribute to our vision of health with heart.

Role Summary:

The Insurance Risk Analyst plays a pivotal role in managing the organization's insurance portfolio, overseeing claims processes, and ensuring the safety of our patients. This position is essential for minimizing risks and improving the overall quality of care provided.

Key Responsibilities:

Insurance Portfolio Oversight:
  • Administer the organization's insurance portfolio, ensuring comprehensive coverage for all potential liabilities.
  • Oversee the acquisition, renewal, and management of the internal insurance program, handling daily administrative tasks related to various coverage lines.
  • Evaluate external contracts and provide guidance on insurance-related provisions and requirements.
  • Manage the issuance of certificates of insurance.
  • Act as a liaison between the organization, insurance brokers, adjusters, and legal representatives involved in claims.
  • Assess risk evaluations against insurance costs and offer financial recommendations to enhance outcomes.
  • Collaborate with colleagues and management on projects focused on risk assessment and mitigation.
  • Collect and analyze necessary underwriting data.
  • Stay informed about changes in risk exposures and market conditions.
  • Respond promptly to audit inquiries.
Claims Administration:
  • Work closely with the legal department to manage all insurance claims, ensuring thorough documentation and communication with insurers.
  • Coordinate with relevant teams to gather essential information and evidence for claims processing.
  • Track the status of claims to ensure timely resolution and settlement.
Incident Oversight:
  • Develop and implement systems for incident reporting and management.
  • Conduct comprehensive investigations of incidents, accidents, and near-misses to identify root causes and recommend corrective measures.
  • Maintain detailed records of incidents and analyze trends to formulate proactive risk management strategies.
  • Lead the incident management and patient safety committee to review incidents and address safety concerns.
Patient Safety Initiatives:
  • Collaborate with clinical and administrative teams to foster a culture of safety and continuous improvement.
  • Lead initiatives focused on patient safety, including risk assessments and safety audits.
  • Analyze patient safety data to identify trends and develop strategies to minimize adverse events.
Regulatory Compliance and Reporting:
  • Ensure adherence to all relevant regulations, standards, and guidelines related to risk management and patient safety.
  • Prepare and present regular reports on risk management activities and patient safety outcomes to senior leadership.
  • Stay updated on industry trends and regulatory changes affecting healthcare.
Training and Development:
  • Design and deliver training programs for staff on risk management and incident reporting.
  • Provide support and guidance to staff on risk-related matters, promoting a proactive approach to risk management.
Additional Responsibilities:
  • Assist the Chief Compliance Officer with internal investigations related to compliance issues and implement corrective actions as necessary.
  • Monitor follow-up actions to resolve identified compliance concerns and ensure proper documentation.
  • Identify potential compliance risks and collaborate with leadership to develop mitigation strategies.
  • Build effective working relationships across various business units.
  • Engage in professional organizations to remain informed about leading industry practices.
  • Perform other duties as assigned.

Qualifications:

  • Bachelor's degree in Healthcare Management, Risk Management, or a related discipline (Master's degree preferred).
  • A minimum of 5 years of experience in healthcare risk management and insurance.
  • Strong understanding of insurance processes, claims management, and regulatory requirements.
  • Certification in risk management (e.g., CPHRM) is desirable.
  • Excellent project management, analytical, and problem-solving skills.
  • Exceptional communication and interpersonal skills, with the ability to thrive in a dynamic environment.
  • Proficient in risk management software and incident reporting systems.
  • Strong attention to detail and ability to manage multiple priorities effectively.

Work Environment:

This position requires the ability to perform essential duties satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to fulfill the essential functions of the role.

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