Health Risk Strategist

Company Details

Berkley Accident and Health is a risk management company that designs innovative solutions to address the unique challenges of each client. With our entrepreneurial culture and a strong emphasis on analytics, we can help employers better manage their risk. We offer a broad range of products, including employer stop loss, benefit captives, provider stop loss, HMO reinsurance, and specialty accident. The key to Berkley’s success is our nimble approach to risk – our ability to quickly understand, think through, and devise a plan that addresses each client’s challenges, coupled with the strong backing of a Fortune 500 company. Our parent company, W. R. Berkley Corporation, is one of the largest and best managed property/casualty insurers in the United States.

#LI-AV1 #LI-Remote

The Company is an equal employment opportunity employer.  Health Risk Strategist (RN) | Stop Loss | Population Health | Case Management | Remote/Hybrid

Responsibilities

The Health Risk Strategist (HRS) reports to the AVP, Clinical Health Risk Management and serves as a strategic resource supporting Berkley's Health Risk Management initiatives. The HRS partners with clients and internal stakeholders to identify health risks, evaluate cost containment opportunities, and implement population health and clinical management strategies that improve outcomes and optimize healthcare spend.

A key responsibility of this role is to work collaboratively with the Clinical Consultant, Cost Containment RNs to ensure identified risks lead to clinical interventions, referral activity, member engagement, and measurable outcomes. By strengthening the connection between risk identification, clinical solutions, and member engagement, the HRS helps clients better understand the value of health risk management programs while improving overall program effectiveness.

The HRS also supports innovation through the evaluation and adoption of technology-enabled solutions, including AI and analytical tools, such as Copilot, to improve efficiency, standardize analyses, enhance reporting capabilities, and reduce manual preparation efforts.

This position can either be fully remote (if not within commutable distance to the office) or based in one of our offices:

• Hamilton Square, NJ
• Marlborough, MA

Our offices offer a hybrid work schedule with 4 days in the office; and 1 day remote where it makes sense to do so.

What you can expect:

• Culture of innovation, teamwork, supportive colleagues and leaders willing to invest in talent
• Internal mobility opportunities
• Visibility to senior leaders and partnership with cross functional teams
• Opportunity to impact change
• Benefits – competitive compensation, paid time off, comprehensive wellness benefits and programs, employer funded health savings account, profit sharing, 401k, paid parental leave, employee stock purchase plan, tuition assistance and professional continuing education

We'll count on you to:

• Conduct health risk assessments, population health reviews, and claims analysis.

• Identify emerging trends, high-cost claim drivers, and intervention opportunities.

• Analyze clinical, claims, pharmacy, and utilization data to develop actionable recommendations that improve health outcomes and reduce healthcare costs.

• Partner with Clinical Consultant, Cost Containment RNs to connect identified risks to interventions and referrals.

• Participate in reviews of complex and high-cost claims to identify opportunities for care management, cost containment, and vendor engagement.

• Monitor referral activity, engagement, outcomes, and program effectiveness.

• Serve as a trusted advisor to clients, captive programs, brokers, TPAs, vendors, and internal business partners regarding population health, clinical risk management, and cost containment opportunities.

• Present recommendations, program results, and health risk insights to internal and external stakeholders in a clear and meaningful manner.

• Foster strong relationships that promote collaboration, improve engagement, and support successful implementation of health risk management programs.

• Measure and report program performance and outcomes.

• Evaluate and pilot innovative technologies including Copilot.

• Collaborate with internal stakeholders to identify opportunities for workflow automation, process improvement, and enhanced data analysis.

• Support organizational innovation initiatives and contribute to the development of scalable, technology-driven health risk management practices.

• Support client implementations, strategic initiatives, and special projects.

Qualifications

What you need to have:

• Degree in Nursing with active, unrestricted nursing license in state of residence.
• Experience in Stop Loss, Managed Care, Population Health, Case Management, and healthcare cost containment.
• Strong analytical, communication, and relationship management skills.
• Ability to translate data into actionable recommendations.
• Experience collaborating across clinical, claims, and client-facing teams.
• Proficiency with Microsoft Office applications and analytics tools.
• Knowledge and experience using AMS Suite of products including Profiler preferred but not required.
• Ability to travel 10-20%.

Additional Company Details

We do not accept any unsolicited resumes from external recruiting agencies or firms. The company offers a competitive compensation plan and robust benefits package for full time regular employees which for this role include: • Base Salary Range: $100,000 - $120,000 • Eligible to participate in annual discretionary bonus • Benefits: Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit-Sharing plans. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment.

Sponsorship Details

Sponsorship not Offered for this Role