Clinical Risk Analyst

Primma, LLC•Roslyn, NY

11d•Onsite

About The Position

The Clinical Risk Analyst works with the Underwriting Department and an EmPRO-employed physician to evaluate medical records, legal documents, and expert opinions in order to assess potential liability, risk exposure, and financial impact for current and prospective insured physicians. This role also develops data-driven analyses to identify medical and malpractice trends that may impart future risk to the Company. Important Note: This position offers meaningful opportunities to learn and grow. While prior experience is valued, EmPRO provides structured onboarding, ongoing training, and support to help candidates develop the knowledge and skills necessary to succeed.

Requirements

Openness to a new career direction; demonstrating a growth mindset and willingness to learn. Candidates will receive support thorough onboarding and in working with EmPRO’s underwriting physician. There are also opportunities for career development through EmPRO’s Educational Assistance Program.
Degree in any of the following areas is required: physician, physician assistant, nurse practitioner, insurance, risk management, healthcare administration, or nursing.
Minimum of 3 years with direct healthcare experience is required.
Minimum of 3 years of experience in professional liability insurance is highly preferred, with direct experience in claims analysis, underwriting, or a related field.
Proficiency in interpreting and analyzing medical and legal documents.
Experience with medical terminology and healthcare systems preferred.
Knowledge of state-specific insurance regulations and legal frameworks related to professional liability preferred.
Strong analytical and problem-solving skills with a keen attention to detail required.
Excellent written and verbal communication skills, with the ability to present complex information clearly and concisely.
Proficiency in data analysis and reporting tools (e.g., Microsoft Excel, claims management software). Analytic programming languages such as R are not required but would be viewed as an asset.
Ability to work independently and collaboratively in a fast-paced, deadline-driven environment.
Demonstrated ability to maintain confidentiality and handle sensitive information with discretion.
Capacity to work on short, intermediate, and long-range projects while also being able to meet tight deadlines.
Strong and deliberative planning skills
Must be detail-oriented and have good organizational skills.
Ability to effectively communicate with others in a professional manner.
Ability to function in a professional office environment and utilize standard office equipment.

Nice To Haves

Advanced clinical degree or Legal Nurse Consultant certification is not required but would be viewed as a strong asset.
Analytic programming languages such as R are not required but would be viewed as an asset.

Responsibilities

Collaborate with the lead underwriter and EmPRO’s underwriting physician to evaluate policy renewals, focusing on high-risk accounts or those with a history of claims.
Develop and maintain underwriting guidelines as it pertains to risk assessment on new and renewal business.
Research and prepare files for potential remediation up to non-renewal of an insured’s policy, as well as physician teleconference meetings.
Attend non-renewal meetings and prepare summary post meeting analysis for underwriting management.
Assess conditional renewal cases, gathering additional information as needed to determine appropriate policy terms, conditions, and pricing.
Provide data and analysis to support decisions on non-renewals, clearly articulating the rationale based on risk factors and claims history.
Work hand in hand with Preverity to build and enhance work streams to ensure rate and risk adequacy on accounts. This would include improving automation and defining triggers for monitoring our insureds’ practice.
Defining research projects for the purpose of generating actionable knowledge to inform Underwriting of important data trends.
Work in conjunction with the assigned underwriter and claims representative to review and analyze incoming professional liability claims.
Review medical records, legal documents, and expert opinions to determine the potential liability, perform risk assessment and financial exposure.
Prepare detailed claims summaries and present findings to the underwriting team and management for review and decision-making.
Identify trends and patterns in claims data to inform underwriting guidelines and risk mitigation strategies.
Develop and maintain reports on key performance indicators (KPIs) related to claims frequency, severity, and underwriting performance.
Assist in the preparation of reports for senior management, providing insights into the overall health of the professional liability portfolio.
All other duties deemed appropriate by management.