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Part Time Lecturer - Integrative Health And Wellness
Recruited by Northeastern University 1 year ago Address Boston, MA, United States

Lead Clinical Risk Consultant - Accident And Health

Company

QBE
Address , Marblehead, 01945, Ma
Employment type FULL_TIME
Salary $98,000 - $146,000 a year
Expires 2023-07-14
Posted at 1 year ago
Job Description
Primary Details
Time Type: Full time
Worker Type: Employee
At QBE, our purpose is to give people the confidence to achieve their ambitions inside and outside of work. From development opportunities, to flexible work options and highly competitive reward and benefits packages, we understand the importance of living our values when it comes to our people. Everything we do at QBE is underpinned by our company’s cultural elements – because we know it's not just what we do that matters, it's how we do it that makes the difference.
This opportunity is accountable for leading the execution of risk assessments for Accident and Health (A&H) within area of responsibility by conducting risk assessments and risk control evaluation, monitoring changes in regulatory requirements and communicating with managers to capitalize on opportunities for continuous improvement and drive the achievement of A&H risk management objectives.
Primary Responsibilities
  • Assess information provided in the form of large claims reporting and clinical notes to identify cost containment opportunities and make referrals for cost containment measures when appropriate
  • Responsible for reviewing medical necessity/experimental criteria and coordinate with outside medical expert
  • Effectively explain complex clinical conditions to a lay person
  • Adopt QBE values in personal work behaviors, decision-making, contributions and interpersonal interactions; mage own career development by soliciting feedback and valuing other perspectives
  • Provide concise, detailed and accurate reporting of data analysis findings, observations and recommendations
  • Determine need for extra-contractual agreements and/or engagement of specialty resources
  • Present in-house clinical education to Underwriting, Policy and Claims team to further understand high cost diagnoses and clinical treatment trends
  • Review transplant contracts and other vendor negotiation/selections with new team members from a quality control perspective to ensure best options were recommended
  • Manage budgeted resources by anticipating expenditures, accurately forecasting resource needs/costs and properly accounting for expenses to meet requirements and achieve fiscal responsibility
  • Serve as the subject matter expert for claims and underwriting related to risk management of claims
  • Contribute to a positive environment by demonstrating cultural expectations and guiding leaders to reward performance and value “can do” people, accountability, diversity and inclusion, flexibility, continuous improvement, collaboration, creativity and fun
  • Provide clinical assessment and recommendations related to setting reserves on large dollar claims on a monthly and as needed basis
  • Consult with internal and external clients on high cost, complex claims and successfully engage effective clinical risk management strategies
  • Provide 1-on-1 training to new team members on all aspects of the role including system functionality, operational expectations and report management
  • Perform new business and renewal large claims reviews and disclosure assessments through the evaluation of clinical and claims data to identify and quantify known and potential risk
  • Utilize a comprehensive approach to risk mitigation within area of responsibility by monitoring regulatory changes to ensure ongoing adherence to reporting requirements
  • Build relationships with key stakeholders by utilizing individual credibility and applying business acumen to communicate risk factors, resolve complex inquiries and develop recommendations for continuous improvement and alignment with overall A&H risk strategy
  • Responsible for clinical thought leadership including participating in product development and delivering educational presentations

Required Education
  • Bachelor's Degree or equivalent combination of education and work experience

Required Experience
  • 7 years relevant experience

Required Licenses/Certifications
  • Registered Nurse (RN)

Preferred Competencies/Skills
  • Analyze and synthesize data to form options and recommendations
  • Establish a high degree of trust and credibility with others
  • High attention to detail
  • Effectively and efficiently present logic, reasoning, and analysis to others
  • Analyze complex risks to ensure organizational competitiveness and satisfaction of established long-range objectives; evaluate causal relationships
  • Effectively present thoughts to key stakeholders to influence adoption of innovative recommendations
  • Build long-term collaborative working relationships with senior managers Apply business and financial acumen
  • Utilize effective research, interview and investigative techniques to gather requirements and analyze information surrounding an issue or request
  • Communicate outside and across the organization and share information as a positive aid to achieve best practice and objectives

Preferred Licenses/Certifications
  • Certified Case Manager (CCM)

Preferred Knowledge
  • Working knowledge of insurance policy and contract language
  • Advanced working knowledge of relevant legal and regulatory requirements
  • Advanced working knowledge of Microsoft Excel, Access and system tools utilized for risk analysis
  • Business and management principles involved in strategic planning and resource allocation
  • Advanced working knowledge of business operations within area of responsibility
  • Advanced working knowledge of risk analysis best practices and procedures

QBE Cultural DNA
  • Everything we do at QBE is underpinned by our DNA (which interlinks seven cultural elements) – because we know it's not just what we do that matters, it's how we do it that makes the difference. We expect all employees to role model and inspire the right behaviours that link to our cultural elements:-We are customer-focused-We are technical experts-We are inclusive-We are fast-paced-We are courageous-We are accountable-We are a teamAll employees are expected to adhere to QBE’s Code of Ethics and Conduct and apply sound risk management practices

US Only - Travel Frequency
  • Occasional (approximately 5-10 trips annually)

US Only - Physical Demands
  • General office jobs: Work is generally performed in an office environment in which there is not substantial exposure to adverse environmental conditions. Must have the ability to remain in a stationary position for extended periods of time. Must be able to operate basic office equipment including telephone, headset and computer. Incumbent must be able to lift basic office equipment up to 20 lbs.

US Only - Disclaimer
  • To successfully perform this job, the individual must be able to perform each essential job responsibility satisfactorily. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential job responsibilities.

Job Type
  • Individual Contributor

Global Disclaimer
  • The duties listed in this job description do not limit the assignment of work. They are not to be construed as a complete list of the duties normally to be performed in the position or those occasionally assigned outside an employee’s normal duties. Our Group Code of Ethics and Conduct addresses the responsibilities we all have at QBE to our company, to each other and to our customers, suppliers, communities and governments. It provides clear guidance to help us to make good judgement calls.
Compensation
Base pay offered will vary depending on, but not limited to education, experience, skills, geographic location and business needs
Annual Salary Range: $98,000 - $146,000
AL, AR, AZ, Fresno, CA, CO (Remote), FL, GA, IA, ID, IL (Remote), IN, KS, KY, LA, MI, MN, MO, MS, MT, NC, ND, NE, NH, NV, OH, OK, OR, PA, SC, SD, TN, TX, UT, VA, VT, WI, WV and WY
* * * * *
Annual Salary Range: $108,000 - $161,000
CA (Remote, Irvine and Woodland), Greenwood Village CO, CT, Chicago IL, MA, MD, NY (Remote), RI, Houston TX and WA
* * * * *
Annual Salary Range: $123,000 - $183,000
San Francisco CA, NJ and New York City NY
Benefit Highlights
You are more than your work – and QBE is more than a workplace, which is why QBE provides you with the benefits, support and flexibility to help you concentrate on living your best life personally and professionally. Employees scheduled over 30 hours a week will have access to comprehensive medical, dental, vision and wellbeing benefits that enable you to take care of your health.
We also offer a competitive 401(k) contribution and a paid-time off program. In addition, our paid-family and care-giver leaves are available to support our employees and their families. Regular full-time and part-time employees will also be eligible for QBE’s annual discretionary bonus plan based on business and individual performance.
QBE recognizes that exemplary benefits extend beyond benefits coverage and compensation. Flexibility in your working environment is important to maintaining balance and QBE is dedicated to ensuring employees achieve personal and professional integration by providing the opportunity for hybrid work arrangements.
How to Apply:
To submit your application, click "Apply" and follow the step by step process.
Equal Employment Opportunity:
QBE is an equal opportunity employer and is required to comply with equal employment opportunity legislation in each jurisdiction it operates.