Lead Medical Risk Consultant

About the position

The purpose of this role is to provide consultancy advice and training to enhance knowledge of the valuation industry and property market trends across Service Delivery and Risk business units, as well as to lead risk assessments for Accident and Health (A&H) by evaluating risks, monitoring regulatory changes, and driving continuous improvement to achieve A&H risk management objectives.

Responsibilities

• Perform new business and renewal large claims reviews and disclosure assessments through clinical and claims data evaluation to identify and quantify risks.
• Provide concise, detailed, and accurate reporting of data analysis findings, observations, and recommendations.
• Serve as the subject matter expert for claims and underwriting related to risk management.
• Provide clinical assessment and recommendations for setting reserves on large dollar claims.
• Present in-house clinical education to enhance understanding of high-cost diagnoses and treatment trends.
• Responsible for clinical thought leadership, participating in product development and educational presentations.
• Consult with internal and external clients on high-cost, complex claims and engage in effective clinical risk management strategies.
• Review transplant contracts and vendor selections for quality control to ensure the best options.
• Build relationships with key stakeholders to communicate risk factors and develop recommendations for continuous improvement.

Requirements

• Bachelor's Degree or equivalent combination of education and work experience.
• Certifications as a Registered Nurse (RN).

Nice-to-haves

• Strong communication skills, with ability to explain and justify work product.
• High attention to detail.
• Strong analytical skills to spot patterns and analyze reports.
• Proficiency in Excel for sorting and reviewing data.
• Understanding of the healthcare continuum and its operations.
• Experience in case management.
• Ability to work with limited information, particularly in contexts where comprehensive data is not available.

Benefits

• Hybrid Working – a mix of working from home and in the office.
• 22 weeks of paid leave for family growth, with 12 weeks available to all parents on a gender-equal basis.
• Competitive 401(k) program with company match up to 8%.
• Well-being program including holistic wellbeing coaching, gym membership, confidential counselling, financial and legal advice.
• Tuition Reimbursement for professional certifications, and continuing education.
• Employee Network and Community – QBE actively supports six Employee Networks, and many ways to give back to your community.