As a Risk Control Specialist, RN, you'll help build trusted client relationships, deliver exceptional service, and provide proactive guidance that helps clients confidently navigate an evolving risk landscape.
Compensation
Salary Range: $150,000–$180,000 annually
Responsibilities
Develop and deliver risk management plans and service strategies based on claims data, loss trends, workers' compensation results, property and casualty exposures, and client priorities
Analyze claims information, loss runs, and operational performance indicators to identify opportunities for risk reduction and quality improvement
Conduct risk assessments and operational reviews to evaluate business practices, identify exposures, and recommend preventive measures
Develop educational programs, training materials, and risk management resources for virtual, in-person, and on-demand delivery
Create practical client tools, including checklists, reference materials, alerts, and best-practice resources that support ongoing risk management efforts
The Pharmacy Relations Specialist (PRS II) is a highly motivated professional with at least 2 years of successful experience working in a pharmacy or interfacing directly with pharmacies or accounts, preferably in healthcare. Responsibilities include executing contracts with pharmacies, responding to pharmacy inquiries, and completing the tactical and operational tasks required to maintain contracted pharmacy networks.
Manage pharmacy contracting process with independent pharmacies and select chains/PSAOs and assist management with network negotiations; inclusive of redline reviews
Review pharmacy contract setup to ensure compliance with pharmacy network agreements
Support pharmacy audits and network compliance initiatives
Research and problem solve to resolve claim issues and concerns
Respond to and track requests, inquiries, and communications with network pharmacies
Requirements
College or 2-year Technical Degree or equivalent experience
Nice to have: Certified Pharmacy Technician
Nice to have: Retail pharmacy experience
Nice to have: Managed care pharmacy setting experience
Responsible for handling complex cyber claims, managing relationships with counsel and vendors, and providing claim trend information to underwriters and actuaries.
Compensation
AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities.
Responsibilities
Investigating, analyzing, and evaluating claims to assess coverage liability and damages across first- and third-party cyber incidents
Formulating claims and litigation strategies
Coordinating with and supporting the engagement of outside counsel and third-party vendors
Identifying liability and coverage trends and issues
Facilitating the collection and analysis of claims-related data for analytic purposes
Requirements
Nice to have: cyber/data privacy litigation experience
The Clinical Claim Editing Specialist serves as the department's clinical and coding subject matter expert and is responsible for the clinical coding review, analysis, development, implementation, validation, and ongoing monitoring of claims payment edits and reimbursement policy rules.
Responsibilities
Serve as the primary clinical and coding subject matter expert for Claim Editing team
Provide clinical interpretation and coding expertise related to CPT, HCPCS, ICD-10-CM, ICD-10-PCS, modifier usage, and other industry-standard coding methodologies
Review medical records, claims data, provider documentation, and supporting clinical information to determine whether billed services are appropriately documented, coded, and reimbursable
Evaluate the clinical appropriateness and coding logic of proposed claim edits, vendor recommendations, and reimbursement policies
Provide clinical and coding guidance for complex claims, appeals, provider inquiries, and reimbursement disputes
Handle a broad range of mainstream and moderately complex auto, general liability, and excess/umbrella claims, including analysis, negotiation, and resolution.
Perform day to day duties and testing of contract implementation, including UAT to ensure that systems accurately reflect a contract's negotiated terms.
Locations (2)
Pennsylvania, United States
United States
Compensation
Pay Range: $23.23 - $39.61 per hour
Responsibilities
Perform audits of provider setup within the provider information system to ensure accurate contract implementation and subsequent claims processing
Review and price contract related pends to ensure claims payment accuracy
Ensure accurate contract implementation and subsequent claims processing through provider setup, UAT testing, etc. on basic Change Requests (CRs) (i.e.RHCs/FQHCs/fee schedule updates)
Troubleshoot and problem solve contract implementation issues related to basic system configuration
Review contracts and assign pay classes and applicable provider information based on contract language
Support program integrity and medical review initiatives as an expert medical examination consultant.
Compensation
full-time, long-term contract role
Responsibilities
Perform detailed clinical and administrative reviews to ensure medical necessity, accuracy of care, and compliance with state and federal healthcare regulations.
Conduct comprehensive medical record reviews, claim evaluations, and clinical assessments related to program integrity and medical examination activities.
Evaluate documentation for medical necessity, appropriateness of care, coding accuracy, and regulatory compliance.
Identify potential indicators of fraud, waste, abuse, or quality concerns.
Analyze clinical data, utilization trends, and provider documentation, preparing detailed findings and recommendations to support corrective actions and program oversight.
Requirements
Active Registered Nurse (RN) license
Nice to have: Experience with medical record reviews
Support private equity due diligence efforts by conducting comprehensive property & casualty insurance due diligence and risk assessments for prospective acquisitions and portfolio companies.
Responsibilities
Perform insurance due diligence for private equity clients undergoing mergers, acquisitions, and other transactions
Identify potential liabilities, coverage gaps, and insurance-related risks
Analyze claims data, loss trends, insurance costs, and program structures
Prepare client-ready reports, presentations, and recommendations
Partner with investors, attorneys, lenders, accountants, and Scott production team members
Requirements
Bachelor's degree in Risk Management, Finance, Business Administration, Economics, Accounting, Insurance, or a related field
The base salary range for this position is $119,000-$150,000 annually. The offered rate of compensation will be based on individual education, experience, qualifications and work location.
Responsibilities
Review and analyze complex coverage issues and prepare coverage position letters.
Investigate, analyze, and evaluate liability and damages to support effective claim resolution.
Manage and provide strategic direction to outside counsel throughout the life of a claim.
Prepare comprehensive case summary reports for matters involving significant reserves, litigation, or trial activity.
Establish timely and appropriate case reserves based on claim exposure and evolving developments.
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