Medical Risk Process Improvement & Training Consultant

Symetra offers a thrilling chance to become part of our team as a Medical Risk Process Improvement & Training Consultant!
About The Role
Responsible for developing and delivering training, supporting team member development, and improving processes to promote quality, consistency, and efficiency within the Medical Risk Consultant (MRC) team. This role combines clinical nursing expertise with process ownership and quality oversight to strengthen medical risk assessment practices. The position also performs medical risk reviews to support Underwriting in evaluating potential risks associated with Stop Loss coverage.
What You Will Do
Medical Risk Assessment Training and Education Develop, maintain, and oversee a structured MRC training framework that supports onboarding, role-specific learning, competency development, and ongoing refresher education. Design, facilitate, and continually improve training through virtual instructor-led sessions, interactive case-based discussions, guided practice, and self-directed learning resources. Create a supportive and engaging remote learning environment that encourages active participation, open communication, collaboration, and accountability. Establish and consistently reinforce clear expectations for professionalism, preparedness, participation, and engagement throughout the training process. Promote effective virtual learning practices, including appropriate use of cameras, interactive discussions, knowledge checks, and regular opportunities to assess understanding, in alignment with company policies and individual accommodation needs. Apply clinical expertise and adult learning principles to help trainees understand how medical information, claims experience, and other available reporting contribute to the evaluation of potential risk within a Stop Loss underwriting environment. Recognize the unique challenges of remote learning and adapt training approaches to individual needs while maintaining consistent expectations for competency, quality, and readiness for independent production. Identify learning needs through trainee assessments, operational trends, quality review findings, and evolving business priorities. Provide training and educational support to Claims, Underwriting, Sales, third-party administrators, and other business partners when knowledge or process gaps are identified. Translate complex clinical, insurance, and operational information into clear, practical learning materials, including procedures, job aids, reference guides, and other resources that support understanding and consistent application. Coordinate appropriate review of specialized content. Maintain organized training resources and documentation, including curriculum maps, job aid libraries, assessment materials, trainer guides, and training records. Pilot new or significantly revised training content before broader implementation and evaluate effectiveness through competency assessments, time to independent production, and post-training quality results. Review the overall training framework at least annually to ensure it continues to meet the needs of the MRC team and the organization.
Process Ownership and Continuous Improvement Serve as the primary resource and designated owner for assigned MRC processes, procedures, standards, and supporting documentation. Regularly evaluate existing workflows to identify opportunities to strengthen quality, efficiency, consistency, internal controls, documentation, and the customer experience. Develop and implement routine process improvements within the MRC function that align with established policies, regulatory requirements, business objectives, and the responsibilities and authority of the role. Share proposed changes through the established leadership review process, outlining the identified need, recommended approach, anticipated impact, implementation plan, and measures of success. Recognize opportunities for team member learning and professional growth by identifying improvements that may be appropriate for other Medical Risk Consultants or colleagues to lead. In these situations, provide supporting analysis, guidance, resources, and coaching to help the assigned individual successfully develop and present the proposed change. Obtain appropriate leadership and stakeholder approval before implementing changes that materially affect other departments, customer experience, systems, contractual obligations, regulatory or compliance requirements, staffing, financial controls, or significant business risk. Guide approved improvements from initial identification through implementation, including gathering requirements, evaluating potential impacts, coordinating with stakeholders, maintaining documentation, communicating changes, providing education, and assessing outcomes. Support team members leading assigned improvement initiatives by helping define the scope, providing clinical and technical guidance, and offering appropriate oversight. Investigate recurring operational challenges and process breakdowns to understand contributing factors and identify sustainable solutions. Maintain documentation of significant decisions and approvals, monitor outcomes following implementation, and recommend additional adjustments, escalation, or reversal when results do not meet expectations or introduce unintended risks.
Clinical Risk Review and Production Support Apply a strong foundation of clinical nursing knowledge, professional experience, and critical thinking to medical risk assessment. Develop and maintain proficiency in Medical Risk Consultant methodology, including the ability to interpret medical and claims-related information, identify potential areas of concern, and communicate findings that support informed underwriting decisions. Partner with Underwriting to evaluate paid claims reports, claimant disclosures, and other available medical and claims-related information to identify individuals with complex, catastrophic, or potentially high-cost medical conditions that may present increased risk under a Stop Loss contract. Use clinical knowledge, research skills, and sound professional judgment to evaluate diagnoses, treatment patterns, anticipated healthcare utilization, emerging therapies, and potential future medical costs. Bring together relevant information to develop clear, well-supported claimant assessments that help Underwriting understand the medical circumstances, potential financial exposure, and considerations relevant to underwriting decisions. Prepare accurate and timely written medical risk assessments in accordance with established procedures and service expectations. Remain engaged in medical risk reviews to strengthen and maintain knowledge of MRC practices, support meaningful training, evaluate process and system changes, and assist with production during periods of increased volume. Sustained production volume remains the primary responsibility of the Medical Risk Consultant role. Serve as a knowledgeable clinical resource by providing professional opinions, second opinions on complex risk assessments, and education to Medical Risk Consultants, Claims Examiners, Underwriters, and other internal and external partners. Coordinate additional clinical or underwriting review support when specialized expertise is needed.
Trainee Development and Readiness Assessment Evaluate trainee progress through observation, knowledge assessments, case-based learning, practice reviews, and other established methods that measure understanding and skill development. Review work completed during the training period to assess application of procedures, documentation quality, clinical reasoning, interpretation of medical and claims information, and readiness to perform medical risk reviews independently. Provide timely, thoughtful, and constructive feedback that reinforces strengths, supports learning, and clearly identifies areas where additional development may be beneficial. Create individualized coaching plans, practice opportunities, job aids, or other learning resources when additional reinforcement is needed. Promote a culture of accountability, professionalism, and continuous learning by establishing clear training expectations and consistently reinforcing established quality standards. Balance an encouraging and supportive coaching approach with thoughtful assessment of each trainee’s demonstrated knowledge, clinical reasoning, engagement, and ability to work independently. Address learning gaps promptly and constructively, ensuring recommendations for training completion and production readiness are supported by documented competencies and established expectations. Maintain accurate documentation of completed training, assessment results, demonstrated competencies, and areas identified for continued development. Communicate trainee progress, strengths, learning needs, and readiness recommendations to the trainee’s manager at established checkpoints, supporting a collaborative approach to successful onboarding and transition into independent production. Make recommendations regarding training completion and production readiness. Final decisions regarding work assignments, performance management, formal counseling, corrective action, or discipline remain with management. Conduct structured quality reviews of each Medical Risk Consultant’s work during the established post-training monitoring period, providing meaningful feedback and reinforcement as appropriate. At the conclusion of that period, transition ongoing performance monitoring to the employee’s manager and the applicable quality assurance process.
Quality Review and Continuous Learning Develop, maintain, and carry out a structured quality audit and feedback process that promotes consistent medical risk assessment practices and supports ongoing learning within the MRC

Skills
Process Improvement

Experience
5-8 yrs

Work arrangement
Yes