Clinical Consultant – Accident & Health

Skyward Specialty Insurance

. Ensure effective risk management through reviews and assessment of new business and renewal large claims/disclosures .

Posted 9/30/2026full-timeRemote • United StatesMid-LevelSenior💰 $80,000 - $130,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in clinical and case management, with a strong focus on risk management, claims analysis, and client relationship development. Proficient in evaluating complex clinical conditions and implementing effective cost mitigation strategies.

Highest-signal resume keywords

Clinical And Case Management ExperienceRN LicenseCCM CertificationClaims AnalysisRisk Management Strategies

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical Data EvaluationCost Mitigation StrategiesMedical Necessity DeterminationClaims AuditsTransplant Care ReviewsComplex Care ReviewsReserve RecommendationsSpreadsheet Analysis

Soft Skills

Excellent Communication SkillsMulti-taskingTeam OrientedRelationship Building

Tools & Technologies

ExcelWord

Certifications & Qualifications

RN LicenseCCM Certification

Industry Keywords

Accident & Health ClaimsStop LossReinsuranceQuality ImprovementCase Management

About the role

Key responsibilities & impact

Ensure effective risk management through reviews and assessment of new business and renewal large claims/disclosures
Assist underwriters in evaluating clinical and claims data and provide reporting of analysis findings, observations, and recommendations
Explain complex clinical conditions to the team
Develop and maintain client, TPA, and vendor relationships
Consult with clients and TPAs on case management, alternative levels of care, program development, quality improvement, claims issues, and educational needs
Work with claim teams to develop cost mitigation strategies and achieve effective clinical and financial outcomes
Assist with medical necessity determinations and claim audits
Perform transplant and complex/catastrophic care reviews, including treatment-plan medical necessity and experimental-treatment reviews
Consult on high-cost claims and implement clinical risk-management strategies
Determine the need for extra-contractual agreements or specialty resources and act as liaison until claim completion
Serve as a risk-management resource for claims and underwriting related to Accident & Health claims
Establish and adjust reserve recommendations and review them monthly
Communicate risk factors, resolve complex inquiries, and develop continuous-improvement recommendations

Requirements

What you’ll need

5+ years of clinical and case management experience
RN license required
CCM preferred
Bachelor's degree preferred
Stop loss and reinsurance experience preferred
Excellent written and oral communication skills
Ability to multi-task and prioritize
Team oriented yet able to work independently
Ability to build and maintain strong professional relationships
Proficiency with Excel, Word and spreadsheet analysis

Benefits

Comp & perks

Health and welfare benefits
Tuition and professional certification assistance
401k savings
Elective participation in the Employee Stock Purchase Program
Paid time off
Paid holidays
Child bonding leave
Other employee assistance
Performance-based incentives may be available