Clinical Risk Analyst

Tokio Marine HCC

Clinical Risk Analyst at Tokio Marine HCC, reviewing transplant and neonate cases while implementing cost containment measures and participating in medical underwriting.

Posted 5/26/2026full-timeRemote • 🇺🇸 United StatesMid-LevelSenior💰 $70,700 - $106,100 per yearWebsite

About the role

Key responsibilities & impact

Under limited supervision, reviews transplant and neonate cases and implements cost containment measures
Participates in medical underwriting, vendor monitoring and education
Gather in-depth information from sources about an individual's physical, medical, and psychosocial status
Determine specific objectives and time-specific actions designed to meet the claimant's needs identified in the assessment phase
Organize, secure, and integrate the available resources in order to accomplish the objectives of the case plan
Gather relevant information on an ongoing basis to determine the plan's effectiveness, measure cost benefits, and set accurate reserves
Act as support for renewal underwriting
Educate internal staff and third-party administrators about Stop Loss Group's Specialty Claims Unit services
Serve as a clinical resource for other Medical Underwriting staff based on clinical specialty in transplants

Requirements

What you’ll need

Registered Nurse, Associates degree in Nursing(ADN), or Bachelor's degree in Nursing (BSN)
Strong medical knowledge, including International Classification of Diseases (ICD), Current Procedural Terminology (CPT), medical terminology, COBRA, and HIPPA
Possess and have the ability to apply knowledge of principles, practices, and procedures
Solid written and verbal communication skills with an emphasis on confidentiality, tact, and diplomacy
Advanced organizational and analytical skills; demonstrated ability to manage multiple tasks simultaneously
Knowledgeable of industry changes, legal updates, and technical developments related to the applicable area of the Company’s business to proactively respond to changing business conditions

Benefits

Comp & perks

Comprehensive medical, vision, and dental coverage, with eligibility beginning on your first day of employment
Basic life and disability insurance
401(k) plan with 6% company match
20 days of PTO, two floating holidays, approximately 11 paid holidays, and volunteer time off
Paid parental leave
Access to our award-winning wellness program, including mental health services, fitness network membership, and a complimentary Headspace subscription
Student loan matching program
Employee discount program
An opportunity to do meaningful work and love what you do

ATS Keywords

✓ Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

Registered NurseAssociates degree in NursingBachelor's degree in NursingInternational Classification of Diseases (ICD)Current Procedural Terminology (CPT)medical terminologyCOBRAHIPAAclinical resourcecost containment measures

Soft Skills

written communicationverbal communicationconfidentialitytactdiplomacyorganizational skillsanalytical skillsability to manage multiple taskseducational skillsinterpersonal skills