HIIG A&H has an opening for a Director of Clinical Risk Requirements Management to oversee CRM operations supporting our Medical Stop Loss product. • Bachelor’s Degree with RN license required. Key Job Functions • Ten years of relevant experience in medical underwriting, claims or • Serve as the lead resource for Medical Underwriting & Clinical Claims Management cost containment, preferably with a within the A&H division. stop loss carrier. • Identify potential high dollar medical claims, and project the expected claim costs • Prior clinical experience preferred. for both prospective new business and in-force accounts. • Build strong relationships with internal and external clients to communicate risk factors, projected cost of claims, and facilitate communication with all parties to achieve cost savings on potential high dollar claims. • Manage, mentor and develop the HIIG A&H CRM staff. May 2017 | The Self-Insurer 51
Location About HIIG • Any of the following regional HIIG is a Houston based, fast expanding insurance group that provides creative solutions for offices: our clients’ specialized needs. HIIG writes business throughout the USA and Internationally through its underwriting divisions that include Accident & Health, Construction, Energy, • Malvern, PA, Indianapolis, IN, Professional,Transactional Property, and other Specialty business. Wakefield, MA, Atlanta, GA, Dallas, Visit www.hiig.com and www.hiigah.com. TX, Scottsdale, AZ. Gold Members HIIG A&H offers Berkshire Hathaway Specialty Insurance Seeks Stop-Loss 1. A competitive base salary with Medical Risk Consultant performance based commissions Medical Risk Consultant 2. Leadership development through individualized support and Berkshire Hathaway Specialty Insurance is seeking a medical risk consultant to join their mentoring 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 3. Medical benefits, STD/LTD, Life, and external clients with appropriate clinical assessment of the anticipated care needs and Dental,Vision, 401k, PTO potential costs of identified claimants. 4. Background check including drug screen Interested candidates should email their resume to HR@hiig. 52 The Self-Insurer | www.sipconline.net
Look no further. Everyone claims to keep sight of the customer. But do they really? We do. At Companion Life, you can count on teamwork with individual attention. That’s a real advantage. We anticipate trends, identify opportunities, but, most importantly – we listen to you. We brainstorm with our partners. Together, we create products and solutions or carve out new distribution channels to get an early foothold in the market. Looking to the future is a large part of our vision. We focus on relationships and listening. Together, we’ll go places. Call us. We’ll take the time to listen. stop loss limited benefit health plans 800-753-0404 short-term medical medicare supplement Companion Life’s Specialty Markets Rated A+ by A.M. Best Company. Rating as of Dec. 21, 2016. For the latest rating, visit ambest.com.
Essential Job Functions Requirements • Effectively explain complex clinical conditions to internal and external clients. • Bachelor’s Degree or equivalent combination of education and • Build strong relationships with internal (UW’s, Claims) and external clients (TPA’s, work experience. external CM’s) to communicate risk factors and projected cost of claims. • RN license required. • Evaluate and assess both new business and renewal large claims/disclosure, clinical and claims data to identify known and potential risks and make potential cost • Five years of relevant experience, recommendations to the stop loss underwriting team. preferably with stop loss carrier. • Serve as the lead resource for underwriting in identifying potential large claims, and • Prior clinical experience preferred. to project the expected cost of the potential claim. • Working knowledge of stop loss • Quickly, thoroughly, and correctly assess a potential/actual claim situation to insurance policy and contract successfully influence risk decision makers, resulting in meaningful clinical and/or language. financial outcomes. • Verified knowledge of ESL Office, • Document and effectively communicate claim projections and rationale to stop loss particularly the Underwriting, underwriters. Claims and Policy Administration modules. • Develop a tracking system of claim cost projections and their effectiveness in reducing stop loss claims costs. • Working knowledge of Microsoft Excel. Manage the risks A Long Tradition of Insurance of self-funding. Solutions for Companies that Self-Fund Their Medical Plan Helping to better manage the risks associated with catastrophic claims AIG’s Group Benefits business has decades of experience in helping companies manage the risks of self-funding through stop loss, specified disease organ transplant, group captive, and Taft-Hartley solutions. Learn about all the ways AIG’s Group Benefits business is here for you. Talk to one of our representatives or visit us online at aig.com/us/benefits. The underwriting risks, financial and contractual obligations, and support functions associated with products issued by National Union Fire Insurance Company of Pittsburgh, Pa., are its responsibility. National Union Fire Insurance Company of Pittsburgh, Pa., maintains its principal place of business in New York, NY, and is authorized to conduct insurance business in all states and the District of Columbia. NAIC No. 19445. Coverages may not be available in all states. © 2016. All rights reserved. AIGB100939 R03/16 ABS-28000-16 May 2017 | The Self-Insurer 54
• Excellent oral, written, and interpersonal Do you aspire communication skills to achieve positive to be a published outcomes. author? Do you have • Detail oriented. any stories or opinions on the Interested candidates should email their resumes to Ruth self-insurance and alternati ve Weaver at [email protected]. risk transfer industry that About Berkshire Hathaway Specialty Insurance you would like to share with Berkshire Hathaway Specialty Insurance provides medical your peers? stop loss, commercial property, casualty, healthcare professional liability, executive and professional lines, surety, We would like to in vite you to travel, programs, and homeowners insurance. Visit www. share your insight and submit bhspecialty.com. an article to The Self-Insurer ! 55 The Self-Insurer | www.sipconline.net distributed in a digital and print format to reach over 10,000 readers around the world. The Self-Insurer has been delivering information to the self-insurance /alternative risk transfer community since 1984 to self-funded employ ers, TPAs, MGUs, reinsurers, stop- loss carriers, PBM s and other service providers. Articles or guideline to Editor Gretchen Grote at [email protected] also has advertising opportunities available. Pleasecontact Shane Byars at [email protected] for advertising information.
It’s Your Health Plan Data — TAKE CONTROL Lucent Health continues to innovate compelling and proprietary technology solutions that enable Employers to have more visibility into their healthcare spend and to control it. LucentHealth.com 2 The Self-Insurer | www.sipconline.net
SIIA would like to Recognize our Leadership and Welcome New Members 2016 Board of Directors CHAIRMAN* Jay Ritchie Executive Vice President Tokio Marine HCC – Stop Loss Group Kennesaw, GA PRESIDENT/CEO Mike Ferguson SIIA, Simpsonville, SC TREASURER & CORPORATE SECRETARY* Duke Niedringhaus Senior Vice President, J.W.Terrill, Inc. Chesterfield, MO CHAIRMAN-ELECT* Robert A. Clemente CEO Specialty Care Management LLC Lahaska, PAKennesaw, GA Directors Mary Catherine Person HEALTH CARE COMMITTEE President Kari L. Niblack Adam Russo HealthSCOPE Benefits, Inc. Executive Vice President of Chief Executive Officer Little Rock, AR Client Engagement & Services The Phia Group, LLC Apex Benefits Braintree, MA David Wilson Indianapolis, IN President Joseph Antonell Windsor Strategy Partners, LLC INTERNATIONAL COMMITTEE CEO/Principal Princeton Junction, NJ Robert Repke A&M International Health Plans President Miami, FL Committee Chairs Global Medical Conexions, Inc. Novato, CA Kevin Seelman CAPTIVE INSURANCE COMMITTEE Senior Vice President Michael P. Madden WORKERS’ COMP COMMITTEE Lockton Dunning Benefit Company Senior Vice President Stu Thompson Dallas,TX Artex Risk Solutions, Inc. CEO San Francisco, CA The Builders Group Andrew Cavenagh Eagan, MN President GOVERNMENT RELATIONS Pareto Captive Services, LLC COMMITTEE Philadelphia, PA Lawrence Thompson Senior Vice President, Sales & Mark L. Stadler Client Services CEO POMCO Group BridgeHealth Syracuse, NY Denver, CO May 2017 | The Self-Insurer 57
SIIA New Members Regular Corporate Tom Fabris Silver Member Members President MedCost Solutions Charles Lavelle Paul Lavin Canton, OH Par tner President & CEO Bingham Greenebaum Doll LLP American Health Holding Maureen Pfeiffenberger Louisville, KY New Albany, OH Vice President, Client Consulting Murray Securus Alex Giordano Lena Andrews Lancaster, PA President & CEO Vice President/COO Monumental Risk Strategies Benefit Support, Inc. Rafael Carrillo Irving,TX Gainesville, GA CEO My Spine Treatment Center Tom McGraw Elizabeth Turbitt San Diego, CA President & CEO Senior Vice President Noridian Healthcare Solutions Cevian Intermediaries Mary DeWitt Fargo, ND Berwyn, PA Redirect Health Scottsdale, AZ Francesca Hartop Roberta Wachtelhausen CEO SVP & Chief Sales & Marketing Albert Ertel Zebu Compliance Solutions Officer President/CEO Portsmouth, OH ConnectiCare, Inc. Secure Health Plans of Georgia Farmington, CT Macon, GA Employer Member Rick Burd James Pennington Tracy Foss President President & CEO Director of Operations Contribution Health, Inc. The Health Plan Kairos Health Arizona, Inc. Lancaster, PA St. Clairsville, OH Phoenix, AZ Dino Sciulli Libby Henry Marilyn Bar tlett President Risk Consultant Administrator DS Benefits Group Thomas McGee, L.C. State of Montana Medina, OH Kansas City, MO Helena, MT Jeffrey Zavada Chuck Bryan President Senior VP of Sales & Marketing Exceedent LLC XeoHealth Corporation Menomonee Falls, WI Frederick, MD Christopher Moyer Vice President HealthNow Administrative Services Blue Bell, PA William Pace Producer Lockton Companies Memphis,TN 58 The Self-Insurer | www.sipconline.net
Better Service. Better Performance. Experience Zelis Healthcare. Network Solutions Claims Integrity Payments Provides Discounts and Ensures Appropriate Efficient and Timely Access to Networks Reimbursement for Care Payment and Data Zelis Healthcare is a healthcare information technology company that provides solutions which address pre-payment to payment needs across the claims life cycle. Find out what Fully Integrated Healthcare Cost Management can do for you! Visit us at Zelis.com Copyright 2016 Zelis Healthcare. All rights reserved.
Another $500,000 claim? We can help. EthiCare saves claim payors money. Period. 888.838.4422 [email protected] www.EthiCareAdvisors.com
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