Remote Clinical Risk Manager (RN)

Reports To: Vice President, Claims

Department: Claims

Location/Schedule: Remote

Classification: Full-Time/Exempt

Who We Are:

Old Republic is a leading specialty insurer that operates diverse property & casualty and title insurance companies. Founded in 1923 and a member of the Fortune 500, we are a leader in underwriting and risk management services for business partners across the United States and Canada. Our specialized operating companies are experts in their fields, enabling us to provide tailored solutions that set us apart.

Position Overview:

Old Republic Accident & Health is seeking an experienced and highly knowledgeable medical management professional to join our fast-growing team. The Clinical Risk Manager leverages advanced clinical expertise and deep knowledge of medical conditions, clinical guidelines, and healthcare risk to analyze treatment planning, utilization of care, and financial outcomes.

This role leads clinical and cost-analysis efforts supporting claims reimbursement, operating as both a strategic partner and hands-on contributor. The Clinical Risk Manager collaborates with medical underwriting to evaluate risk, identify cost-containment opportunities, and develop current and future cost projections, while playing a key role in influencing underwriting decisions and managing exposure tied to complex, high-cost medical claims.

Essential Job Functions:

• Lead and perform clinical, claims, and cost analyses to assess appropriateness of care and associated costs in support of claims reimbursement activities
• Oversee and conduct medical risk assessments by reviewing and analyzing underwriting documentation to validate data and project medical risk
• Identify and proactively communicate clinical factors that may impact underwriting outcomes or financial exposure, partnering with Underwriters on rating and risk evaluation
• Design and implement clinical risk management strategies for complex, high-cost claims, including identification of cost-containment opportunities
• Apply advanced clinical expertise and evidence-based criteria to evaluate complex data sets and provide guidance on material risks influencing underwriting strategy
• Serve as a clinical subject matter expert and key partner in building and maintaining relationships with internal and external stakeholders, including MGUs, TPAs, captives, brokers, and vendor partners
• Maintain thought leadership by staying current on healthcare trends, clinical guidelines, emerging therapies, medical technologies, and high-cost conditions
• Review claims and clinical data to develop case reserve projections and provide recommendations
• Provide clinical consultation and guidance across all Accident & Health lines of business
• Drive operational efficiencies, support quality assurance initiatives, and contribute to audit readiness and execution
• Ensure full compliance with corporate policies, procedures, regulatory requirements, and service standards

Qualifications:

• Bachelor’s degree required
• Current licensure as a Registered Nurse with 7–10 years of clinical experience
• 5–7 years of experience in the insurance industry required, including stop-loss insurance or reinsurance
• Experience with captive stop loss, group medical, managed care, ancillary benefits, or specialty risk preferred
• Strong analytical, investigative, and problem-solving skills with the ability to interpret complex clinical and financial data
• Comprehensive knowledge of medical terminology, disease processes, treatment protocols, and healthcare industry trends
• Excellent verbal and written communication skills with the ability to collaborate effectively with various internal and external stakeholders
• Highly organized with exceptional attention to detail; strong work ethic and ability to work independently while managing multiple priorities in a fast-paced environment
• Proficiency with Microsoft Office applications (Word, Excel, Outlook) and underwriting systems or related tools (e.g., Connexure, UGAN)
• Willingness to travel to client sites, industry conferences, and other Old Republic locations as needed

ORI is an Equal Opportunity Employer. ORI provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.