Reinsurance Nurse Case Manager

Overview:

Carbon Stop Loss Solutions is a leading managing general underwriter (MGU) in the field of employer stop loss and managed care insurance.

Carbon’s team of experts are known as the industry leader in delivering best-in-class risk solutions to effectively lower healthcare costs. Carbon’s offerings support clients and brokers in a rapidly changing healthcare market with best-in-class service, underwriting, claims support and effective cost containment strategies.

Carbon Stop Loss Solutions is part of NSM Insurance Group, the nation’s leading specialty insurance provider with more than $1.6 billion in premium across 25+ specialty insurance programs and brands in the U.S. and U.K. For more than 32 years, the company has been exclusively focused on building successful insurance programs and continually seeks new opportunities to grow and expand through strategic mergers and acquisitions.

Employee are given endless opportunities to expand their interests and skillsets, push breakthrough ideas and take risks. Our open, supportive environment gives employees the confidence to take ownership of their work as if the business was their own.

At NSM, we Build Success every day for our people, carrier partners, agents and insureds — because we know our success is built on yours.

Carbon Stop Loss Solutions, (formerly known as IOA Re, Sequia and Rockport) is looking for a Registered Nurse who can assist our Claim and Underwriting Departments in managing risk.

Responsibilities:

• Assist underwriters in the timely evaluation of clinical and claim data during the disclosure process to identify potential risk.
• Work with Third-Party Administrators and producers as a medical resource for discussion and assistance with potential catastrophic claim management.
• Assist Case Managers, either employed by our TPAs, or with outside firms, with high dollar catastrophic claimants.
• Evaluate claims reporting for potential exposure and reserve recommendations.
• Clinical review and claims analysis to assess for claim trends and possible group resources.
• Maintain patient confidentiality in compliance with standards set forth by IOA as well as HIPAA.
• Work with the department manager in seeking and employing new business partners to promote health care resources and mitigate claims exposure.
• Serve as a back-up for other department medical staff as needed.
• Maintain licensure and certifications as indicated to promote personal professional advancement.

Qualifications:

• Registered Nurse licensure preferred - bachelor’s degree in nursing or science.
• CCM certification, preferred.
• At least one year of acute care clinical experienced, required.
• UM or CM experience on either the payer or provider side.
• Prior TPA, MGU or Stop loss carrier experience is highly preferable.
• Prior experience analyzing health care claims and coding.
• Prior experience working with catastrophic health care claims.
• Experience with data entry and analysis of medical reporting.
• Provide risk assessment and communicate the analysis succinctly in reporting.
• Ability to conduct independent medical research as an adjunct to medical underwriting tasks.
• Ability to meet tight time frames.
• Strong organizational and time management skills.
• Ability to work independently in a remote setting.
• Ability to work with multiple offices and underwriters and prioritize time frames.
• Strong data entry skills.
• Proficient with MS Office software.
• Ability to communicate effectively and professionally both internally and with external clients.