Reinsurance Nurse Case Manager at NSM Insurance Group, LLC

, , United States -

Full Time

Start Date

Immediate

Expiry Date

09 Jan, 26

Salary

0.0

Posted On

11 Oct, 25

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Registered Nurse, Clinical Experience, Claims Analysis, Risk Assessment, Data Entry, Medical Research, Organizational Skills, Time Management, Communication Skills, Catastrophic Claims, Health Care Claims, Underwriting Support, Confidentiality, Collaboration, MS Office Proficiency, Case Management

Industry

Insurance

Description

Overview Carbon Stop Loss Solutions is a leading managing general underwriter (MGU) in the field of employer stop loss and managed care insurance. Carbon’s team of experts are known as the industry leader in delivering best-in-class risk solutions to effectively lower healthcare costs. Carbon’s offerings support clients and brokers in a rapidly changing healthcare market with best-in-class service, underwriting, claims support and effective cost containment strategies. Carbon Stop Loss Solutions is a big element within Novacore’s Healthcare Segment. At Novacore, we’re entering an exciting new chapter. Novacore is the newly formed specialty insurance entity created from the April 2025 sale of NSM Insurance Group’s U.S. commercial division. While we carry forward a 35-year legacy of deep industry expertise, we’re transforming what commercial insurance can be. The name Novacore reflects our ambition — nova for new and brilliant, core for strength and purpose. We’re building something bold and meaningful, and every team member plays a vital role in that mission. With more than $1.3 billion in premium across 15+ specialty insurance programs, we’re transforming the commercial insurance experience — delivering exceptional value to our agent partners and customers through smarter, faster and more collaborative ways of doing business. We specialize in tailored Property & Casualty and Accident & Health insurance solutions for niche industries, powered by advanced analytics, modern technology and a commitment to innovation at every level. Backed by strong leadership and a fresh vision, we’re bringing together the best of our past with bold new ideas to shape the future of specialty insurance. With a renewed focus, Novacore is positioned to grow and expand through strategic mergers and acquisitions — and to lead the way in the commercial insurance space. The Nurse Case Manager is a registered nurse who can assist Novacore’s Claim and Underwriting Departments in managing risk and mitigating claims exposure. An active RN license is required for this position** Responsibilities Assist underwriters in the timely evaluation of clinical and claim data during the disclosure process to identify potential risk. Work with Third-Party Administrators and producers as a medical resource for discussion and assistance with potential catastrophic claim management. Assist Case Managers, either employed by Carbon’s TPAs, or with outside firms, with high dollar catastrophic claimants. Evaluate claims reporting for potential exposure and reserve recommendations. Clinical review and claims analysis to assess claim trends and possible group resources. Maintain patient confidentiality in compliance with standards set forth by Carbon as well as HIPAA. Work with the department manager in seeking and employing new business partners to promote health care resources and mitigate claims exposure. Serve as a back-up for other department medical staff as needed. Maintain licensure and certifications as indicated to promote personal professional advancement. Qualifications Registered Nurse active license required - BSN preferred. CCM certification, preferred. At least one year of acute care clinical experience. UM or CM experience on either the payer or provider side. Prior TPA, MGU or Stop loss carrier experience is highly preferable. Prior experience analyzing health care claims and coding. Prior experience working with catastrophic health care claims. Experience with data entry and analysis of medical reporting. Provide risk assessment and communicate the analysis succinctly in reporting. Ability to conduct independent medical research as an adjunct to medical underwriting tasks. Ability to meet tight time frames. Strong organizational and time management skills. Ability to work independently in a remote setting. Ability to work with multiple offices and underwriters and prioritize time frames. Proficient with MS Office software. Ability to communicate effectively and professionally both internally and with external clients.

Responsibilities

The Nurse Case Manager assists in managing risk and mitigating claims exposure by evaluating clinical and claim data. They work with various stakeholders to support catastrophic claim management and ensure compliance with confidentiality standards.