💼 Employment Type: Full-Time
📍 Location: Remote (U.S.)
💬 Job Overview
Symetra is hiring a Medical Risk Consultant to support the Stop Loss Underwriting team. In this role, you’ll evaluate high-cost medical cases, estimate potential claim risks, and partner with Third-Party Administrators and Case Management vendors to manage care and contain costs.
This is a highly specialized clinical role perfect for experienced RNs with case management and healthcare claims knowledge. You’ll provide written assessments for underwriters, identify cost-containment opportunities, advise internal teams, and stay current on industry trends, medical treatments, and emerging diagnoses. The impact of your work directly supports financial risk decisions and claimant outcomes.
📋 Key Responsibilities
Review policyholder data to identify individuals with catastrophic or complex medical needs.
Evaluate medical records and claims to estimate potential risk for new and renewal underwriting.
Provide written clinical assessments to Underwriters and RGM teams within defined deadlines.
Review stop-loss claim notices to identify cost-containment opportunities.
Collaborate with TPAs, case managers, and vendors to improve clinical and financial outcomes.
Maintain accurate claimant status, care oversight, and cost-containment documentation.
Serve as a clinical resource and provide training guidance to Claims, Underwriting, Sales, and TPAs.
Offer clinical opinions and research insight to support claims and underwriting decisions.
Identify effective managed care partners and preferred provider networks in assigned regions.
Monitor geographic healthcare trends and notify teams of emerging risks.
Maintain required CE hours and stay updated on medical advances and industry trends.
Participate in special projects and internal education initiatives.
💰 Compensation
Salary Range: $77,600 — $129,400
Eligible for annual bonus program
Full benefits package
🧩 Requirements
Active Registered Nurse (RN) license required.
Associate’s degree required; bachelor’s degree preferred.
4+ years of clinical nursing experience; 2+ years of case management preferred.
2+ years in healthcare or insurance; stop loss or reinsurance experience strongly preferred.
Case Manager Certification (CCM) preferred.
Strong research ability for diagnoses, treatments, and cost ranges.
Proficiency in Microsoft Office (especially Excel).
Excellent written and verbal communication skills.
Strong organizational skills, attention to detail, and the ability to work independently.
Must be authorized to work in the U.S. (no employer sponsorship available).
Remote Work Requirements:
At least 100 Mbps download / 20 Mbps upload
Fiber, cable, or DSL internet only
No satellite, cellular broadband, or wireless-only connections
Speed test proof required
✨ Why You’ll Love This Job
This is a high-impact clinical role where your expertise directly influences risk decisions, claimant outcomes, and cost-containment strategy. Symetra offers flexible schedules, a collaborative culture, and a strong commitment to employee well-being, diversity, inclusion, and professional development.
Employees praise Symetra for its supportive leadership, innovation-focused environment, and excellent work/life balance. The company encourages growth, empowerment, and continuous learning through CE credits, internal training, and mentorship.
🌟 Who This Job Is Perfect For
Experienced RNs looking to transition into insurance, risk, or clinical review roles.
Case managers who enjoy data-driven decision-making.
Clinicians who enjoy autonomy, research, and supporting complex medical decisions.
Nurses who want remote flexibility while using their medical expertise in a new setting.
Professionals who thrive in fast-paced, detail-heavy environments.
🏢 About Symetra
Symetra is a national financial services company providing insurance, employee benefits, and retirement solutions. Guided by the principles of Value, Transparency, and Sustainability, Symetra focuses on long-term stability and genuine customer trust. The company is deeply committed to diversity, equity, inclusion, employee well-being, and supporting local communities.
As a remote-first organization, Symetra invests in flexible work, high-quality tools, an inclusive culture, and strong employee support systems.
🚀 How to Apply
You’ll be redirected to Symetra’s official career portal to complete your application.
