Pareto Capital

Risk

• Review medical records, diagnoses, and treatment plans for individuals and groups with high-cost or complex conditions
• Assess severity, prognosis, and likely progression of illnesses or injuries
• Identify potential high-risk cases, including transplant, oncology, neonatal, and chronic conditions
• Develop evidence-based cost projections for ongoing and future treatment
• Evaluate treatment pathways, including standard of care and emerging therapies
• Estimate timing and magnitude of claims exposure for underwriting purposes
• Partner with underwriters to provide clinical insight on risk selection, pricing, and policy terms
• Support new business and renewal underwriting with case-specific analysis
• Assist in determining appropriate laser levels, exclusions, or coverage strategies
• Analyze appropriateness of care, site of service, and utilization patterns
• Identify opportunities for cost containment or alternative treatment strategies
• Monitor large claims and ongoing cases for changes in risk or cost trajectory
• Translate complex clinical information into clear, actionable summaries for non-clinical stakeholders
• Document findings, assumptions, and rationale for cost projections
• Contribute to reporting on high-cost risks and emerging clinical trends
• Stay current on medical advancements, specialty drugs, gene therapies, and high-cost treatments
• Understand healthcare cost drivers and reimbursement trends impacting stop loss risk

Senior Clinical Risk Consultant