Unum Insurance France France
4 weeks ago
Job Posting End Date: February 26
When you join the team at Unum, you become part of an organization committed to helping you thrive.
Here, we work to provide the employee benefits and service solutions that enable employees at our client companies to thrive throughout life's moments. And this starts with ensuring that every one of our team members enjoys opportunities to succeed both professionally and personally. To enable this, we provide:
• Award-winning culture
• Inclusion and diversity as a priority
• Performance Based Incentive Plans
• Competitive benefits package that includes: Health, Vision, Dental, Short & Long-Term Disability
• Generous PTO (including paid time to volunteer)
• Up to 9.5% 401(k) employer contribution
• Mental health support
• Career advancement opportunities
• Student loan repayment options
• Tuition reimbursement
• Flexible work environments
• All the benefits listed above are subject to the terms of their individual Plans .
And that's just the... beginning...
With 10,000 employees helping more than 39 million people worldwide, every role at Unum is meaningful and impacts the lives of our customers. Whether you're directly supporting a growing family, or developing online tools to help navigate a difficult loss, customers are counting on the combined talents of our entire team. Help us help others, and join Team Unum today
As our Stop Loss Senior Clinical Consultant, you are the clinical subject matter expert responsible for educating Stop Loss Underwriters and providing accurate financial projection and evaluation of medical treatment costs of individuals identified in new and renewal business underwriting process by reviewing medical information pertinent to individual claimants. Considering current, past, and future treatment plans, you are responsible for providing estimates of ongoing risk for each individual claimant within current and upcoming policy periods The Sr. clinician will be measured in terms of the laser accuracy for the high-cost claims and will share in the overall financial performance for the stop loss financials
Principal Duties & Responsibilities:
• Review policyholder data to identify claimants with catastrophic care needs and assess complex medical & claims information available to calculate potential risk.
• Provide accurate financial assessment of the risk which includes projecting the financial liability of the claims while considering both the underlying medical condition and drug costs
• Provide written claimant assessments within established deadlines to the Underwriters to utilize when establishing rates for new and renewal business
• Review potential stop loss claim notices to identify case management and cost containment opportunities to reduce potential excess loss claim expenses.
• Notify appropriate management and underwriters of potential claims involving significant risk.
• Work with Third Party Administrators (TPAs) and external Case Managers utilizing medical and claims management resources to facilitate clinical and financial outcomes for claimants with complex and catastrophic medical conditions.
• Maintain current claimant clinical status, cost containment activities and contact information in system of record.
• Act as a resource to internal and external customers by: Identifying and supporting training opportunities for Claims, Underwriting, Sales, and TPA when knowledge gaps are identified.
• Serve as a role model and coach through continuously educating claims and underwriting professionals on medical assessments.
• Provide clinical opinion from knowledge, experience and/or research to claims examiners and underwriters as requested or deemed appropriate.
• Assess and recommend effective claim cost containment and managed care vendors including preferred provider networks in assigned geographical region.
• Identify geographical healthcare trends in assigned geographic marketplace for potential solution implementation and to warn Underwriting and Sales of any risk impacting trends identified.
• Maintain CE hours to meet State RN Licensure and CCM (or Industry) certification renewal requirements.
• Mentor new team members as needed
Requires deep and working knowledge of the following:
• Standard treatment plans by diagnosis including medical and surgical modalities for adult and pediatric claimants and rehabilitation programs
• Physician interventions including frequency of involvement and specialist interventions
• Current chemotherapy regimens for malignancies both primary and secondary
• Common diagnoses that result in solid organ or hemopoietic transplants and a thorough understanding of the transplant process including the transplant evaluation, listing process, use of a vendor when warranted and the average wait time for all types of transplants
• The care required for the premature neonate and their transition into the home setting
• High-cost drug therapies for specific diagnoses including orphan drugs
• Home care requirements including skilled nursing, rehabilitation, and durable medical equipment
Requires the following experience and skills:
• Registered Nurse
• Bachelor's/Associates degree preferred or relevant experience
• 3-5 years nurse clinical experience and 2+ years case management experience
• 2 + year's experience in health care or health insurance industry; stop loss or reinsurance preferred
• Ability to interpret plan language in specific plan documents to assist with coverage determinations both in an underwriting and claim capacity
• Ability to review a UB -92 and other claim forms to assist with determination of appropriate care based upon diagnoses and treatment provided as well as a cost analysis
• Ability to set claim reserves for designated clients based upon clinical data
• Ability to use varying resources (e.g., systems, applications, and tools) to retrieve data and research diagnoses, treatments, and average costs.
• Strong computer proficiency (MS Word, Outlook, Excel, and PowerPoint)
• Ability to work independently and in team environment
• Strong customer service mentality
• Ability to develop unified internal and external working relationships
• Ability to multi-task and adapt promptly to change
• Excellent written and verbal communication skills
• Strong prioritizing and organization skills
Unum and Colonial Life are part of Unum Group, a Fortune 500 company and leading provider of employee benefits to companies worldwide. Headquartered in Chattanooga, TN, with international offices in Ireland, Poland and the UK, Unum also has significant operations in Portland, ME, and Baton Rouge, LA - plus over 35 US field offices. Colonial Life is headquartered in Columbia, SC, with over 40 field offices nationwide.
The base salary range for applicants for this position is listed below. Unless actual salary is indicated above in the job description, actual pay will be based on skill, geographical location and experience.
Additionally, Unum offers a portfolio of benefits and rewards that are competitive and comprehensive including healthcare benefits (health, vision, dental), insurance benefits (short & long-term disability), performance-based incentive plans, paid time off, and a 401(k) retirement plan with an employer match up to 5% and an additional 4.5% contribution whether you contribute to the plan or not. All benefits are subject to the terms and conditions of individual Plans.
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