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Voya Financial's Downtown Minneapolis location is searching for a Cost Containment Consultant to join our Stop Loss Claims department. This role will impact Stop Loss cost containment through early identification and intervention to reduce third party administrator/company costs.
Serves as subject matter expert in company's cost containment programs, including but not limited to TPAs, Large Case Managers, Sales, Underwriters, Client Representatives, and Brokers. Serve as a consultant to underwriting.
Serves as a subject matter expert in the evaluation of medical information to clarify diagnoses, evaluate the severity of medical conditions, and estimate the duration of recovery. Provides assistance to TPAs with cost containment options for high cost claims including but not limited to: transplants, specialty medications, dialysis, hemophilia, neonatal, and cancers.
Serves as a subject matter expert in analysis of transplant contracts, and provides guidance to the TPA/Case Managers in the selection of the best transplant contract for their client.
Researches clinical conditions and provides analytical review of the medical and/or pharmacy data to formulate the history of events.
Manages vendors and participates in vetting new vendors.
Actively participate in establishing standard work and root cause problem solving for the cost containment team.
Develops relationships with key external and internal stakeholders, and cooperatively facilitates optimal cost savings.
Ability to travel and other duties as assigned.
Knowledge & Experience:
Bachelor's degree - current unrestricted RN license, or equivalent clinical degree
Work at home any location - Home office Minneapolis MN
Transplant case management is preferred
Stop loss reinsurance experience a plus
Minimum 5 years of clinical experience
Minimum 1 year insurance experience, strongly preferred
Analytical and problem solving skills
Excellent interpersonal and negotiation skills to act as a company representative
Experience in Microsoft Office products
At Voya, we have identified the following critical skills which are key to success in our culture:
Customer Focused: Passionate drive to delight our customers and offer unique solutions that deliver on their expectations.
Critical Thinking: Thoughtful process of analyzing data and problem solving data to reach a well-reasoned solution.
Team Mentality: Partnering effectively to drive our culture and execute on our common goals.
Business Acumen: Appreciation and understanding of the financial services industry in order to make sound business decisions.
Learning Agility: Openness to new ways of thinking and acquiring new skills to retain a competitive advantage.
Learn more about Critical Skills.