Medical Risk Specialist

G eneral Summary : The Medical Risk Specialist will work in the Underwriting department reviewing medical records, legal documents, and expert opinions to determine the potential liability, perform risk assessment and financial exposure.

Important Note : This position offers opportunities to learn and grow. While prior experience is valuable, we will provide structured onboarding, ongoing support and training to assist in gaining the knowledge and skills necessary to excel.

Essential Duties & Responsibilities :

• Responsibilities related to Underwriting Support & Policy Management :

Collaborate with the lead underwriter to evaluate policy renewals, focusing on high-risk accounts or those with a history of claims.

• Develop and maintain underwriting guidelines as it pertains to risk assessment on new and renewal business.
• Research and prepare files for potential non-renewals, and physician teleconference meetings.
• Attend non-renewal meetings and prepare summary post meeting analysis for underwriting management.
• Assess conditional renewal cases, gathering additional information as needed to determine appropriate policy terms, conditions, and pricing.
• Provide data and analysis to support decisions on non-renewals, clearly articulating the rationale based on risk factors and claims history.
• Work hand in hand with Preverity to build and enhance work streams to ensure rate and risk adequacy on accounts.
• Claims Evaluation :

Work in conjunction with the assigned underwriter and claims representative to review and analyze incoming professional liability claims.

• Review medical records, legal documents, and expert opinions to determine the potential liability, perform risk assessment and financial exposure.
• Prepare detailed claims summaries and present findings to the underwriting team for review and decision-making.
• Risk Analysis & Reporting :

Identify trends and patterns in claims data to inform underwriting guidelines and risk mitigation strategies.

• Develop and maintain reports on key performance indicators (KPIs) related to claims frequency, severity, and underwriting performance.
• Assist in the preparation of reports for senior management, providing insights into the overall health of the professional liability portfolio.
• All other duties deemed appropriate by management

Education & Qualifications :

• Openness to a new career direction; demonstrating a growth mindset and willingness to learn; candidates will receive support thorough onboarding, guidance and targeted training as they hone their skill development to assist in where experience may be less extensive
• Bachelor's degree in any the following areas required; insurance, risk management, healthcare administration, nursing
• Legal Nurse Consultant certification is not required but would be viewed as a strong asset
• Minimum of 3 years with direct healthcare experience such as nursing required.
• Minimum of 3 years of experience in professional liability insurance is highly preferred, with direct experience in claims analysis, underwriting, or a related field
• Proficiency in interpreting and analyzing medical and legal documents
• Experience with medical terminology and healthcare systems preferred
• Knowledge of state-specific insurance regulations and legal frameworks related to professional liability preferred
• Strong analytical and problem-solving skills with a keen attention to detail required
• Excellent written and verbal communication skills, with the ability to present complex information clearly and concisely
• Proficiency in data analysis and reporting tools (e.g., Microsoft Excel, claims management software)
• Ability to work independently and collaboratively in a fast-paced, deadline-driven environment
• Demonstrated ability to maintain confidentiality and handle sensitive information with discretion
• Must be detail-oriented and have good organizational skills
• Ability to effectively communicate with others in a professional manner
• Ability to function in a professional office environment and utilize standard office equipment

The actual compensation for this position will be determined by experience and other factors permitted by law.