1 business systems specialist jobs found in Itasca, IL

The Clinical Risk Specialist RN is responsible for providing high quality case management and claims management consulting, including identification, assessment and projections of high-cost cases to assist in the underwriting process. ESSENTIAL EDUCATION AND EXPERIENCE : ASN or BSN in nursing licensed in the State of Residence; at least two (2) years of clinical experience, AND at least two (2) years of stop loss or health payer experience. SKILLS/COMPETENCIES REQUIREMENTS: Reviewing stop-loss cases, making recommendations on potential cost of care, including lasers recommendations. Use established guidelines when conducting stop-loss case reviews. Works with underwriting team to identify potential high-risk claimants in new business and renewal groups. Elicits support from sales and account management, and underwriting. Use reporting and risk identification tools on medical and pharmacy claims to assess risk. Assists in responding to inquiries from...