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Medical Risk Consultant

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Berkshire Hathaway Specialty Insurance

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Location:
United States , Atlanta, GA ▼

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Category:
Insurance

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Contract Type:
Not provided

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Salary:

90000.00 - 120000.00 USD / Year
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Job Description:

BHSI has an exciting opportunity for 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.

Job Responsibility:

  • Evaluate and assess both new business and renewal large claims, disclosures, clinical data, and claims data to identify known risks, potential risks, and make projected risk recommendations to the stop loss underwriting team
  • Quickly, thoroughly, and accurately assess a potential and/or actual claim to successfully influence risk decision makers, resulting in meaningful clinical and/or financial outcomes
  • Effectively communicate and document claim projections and rationale to stop loss underwriters
  • Effectively explain complex clinical conditions and treatments utilizing knowledge base, experience, and/or research as requested to internal and external clients
  • Build strong relationships with internal (Underwriters, Claims) and external clients (Third Party Administrators, external Case Managers) to communicate risk factors and projected cost of claims

Requirements:

  • Bachelor’s Degree, or equivalent combination of education and work experience
  • Registered Nurse license required
  • 5+ years of clinical experience
  • 2+ years of medical stop loss experience, preferred
  • Working knowledge of stop loss insurance policy and contract language
  • Excellent oral, written, and interpersonal communication skills
  • Ability to work in high volume, rapid response environment
  • Ability to multi-task and shift priorities as needed
  • Exceptional attention to detail and strong organizational skills are imperative
  • Verified knowledge of ESL Office, particularly the Underwriting, Claims and Policy Administration modules
  • Working knowledge of Microsoft Excel
  • Experience with Excel
  • PDFs
  • AMS
  • David Young System (or similar software supporting stop loss), preferred

Nice to have:

  • 2+ years of medical stop loss experience, preferred
  • Experience with Excel
  • PDFs
  • AMS
  • David Young System (or similar software supporting stop loss), preferred
What we offer:
  • Comprehensive Health, Dental and Vision benefits
  • Disability Insurance (both short-term and long-term)
  • Life Insurance (for you and your family)
  • Accidental Death & Dismemberment Insurance (for you and your family)
  • Flexible Spending Accounts
  • Health Reimbursement Account
  • Employee Assistance Program
  • Retirement Savings 401(k) Plan with Company Match
  • Generous holiday and Paid Time Off
  • Tuition Reimbursement
  • Paid Parental Leave
  • Annual bonus eligibility

Additional Information:

Job Posted:
February 13, 2026

Employment Type:
Fulltime
Work Type:
Remote work
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