Clinical Risk Manager
Swiss Re is one of the world’s leading providers of reinsurance and insurance, and they are seeking an experienced Clinical Risk Manager to join their Accident & Health division. The role involves analyzing medical conditions and associated costs, collaborating with underwriters to evaluate risk, and managing documentation for high-risk individuals. Responsibilities Review medical conditions and respond with a cost analysis coordinated to the Stop Loss case characteristics. Including the review and assessment of large claim reports, shock claim summary reports, trigger reports and large case management notes Identify high risk associated with individuals and communicate required stop loss cost analyzation of current clinical conditions and future cost projections Utilize provided clinical resources such as Predict Dr., NCCN, NORD, and CDC Supply and manage documentation with clinical summary and estimated cost of services for each individual identified as at risk Skills Minimum of Associate or Bachelor's degree in nursing with at least 1 year of Stop Loss Nursing experience Must have up to date registered nurse (RN) license Able to demonstrate a track record of producing work that is highly accurate, shows attention to detail, and reflects well on the organization Proven experience managing multiple projects and working well while handling large volumes of work (with deadlines) Excellent written and verbal communication skills Computer proficiency, specifically strong typing skills and Internet research skills, must have a clear understanding of Microsoft Word, Microsoft Office and Excel Strong clinical background in disease state management/case management experience Background in a Clinical Risk Management position is encouraged but will consider qualified candidates especially those with an oncology or cardiology background Strong analytical and problem-solving expertise Excellent interpersonal skills enabling successful navigation of cross-functional collaboration Ability to prioritize well and work independently with little direct supervision, while handling numerous projects at once Company Overview Swiss Re Group is a wholesale provider of reinsurance, insurance, and other insurance-based forms of risk transfer. It was founded in 1863, and is headquartered in Zürich, Zurich, CHE, with a workforce of 10001+ employees. Its website is Company H1B Sponsorship Swiss Re has a track record of offering H1B sponsorships, with 9 in 2025, 3 in 2024, 7 in 2023, 20 in 2022, 10 in 2021, 7 in 2020. Please note that this does not guarantee sponsorship for this specific role.