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 function. Establish quality review methodology, including file selection and sampling, scoring criteria, review frequency, and documentation expectations. Conduct scheduled reviews of medical risk assessments and supporting documentation completed by Medical Risk Consultants within the post-training monitoring period. Facilitate periodic calibration discussions to promote shared understanding and consistent application of medical risk assessment methods, documentation standards, and quality scoring criteria. Evaluate audit findings to identify patterns, contributing factors, and opportunities for improvement. Use these insights to enhance procedures, job aids, and educational content, and conduct follow-up reviews to confirm that changes have achieved the intended results. Share quality findings, recurring error trends, and training effectiveness measures with Underwriting leadership and the designated quality assurance function at established intervals. Obtain appropriate management or quality assurance validation when findings may affect processes owned by this role. Use quality findings to guide education, coaching, and process improvements. Decisions related to formal performance management, corrective action, or discipline remain the responsibility of management.
• Technology Proficiency and Adoption Serve as a knowledgeable resource for the technology and systems that support MRC medical risk assessment and related workflows. Maintain proficiency with the Microsoft Office Suite, including Word, Excel, Outlook, PowerPoint, and Teams, along with the ability to effectively use the ESL claim system and other platforms required for medical risk reviews, documentation, communication, and reporting. Use Microsoft Office applications to develop and maintain professional training materials, presentations, reference documents, and other resources that support team learning and operational needs. Develop and maintain familiarity with AI-enabled tools and their appropriate application in the business environment. Support responsible use consistent with company expectations for privacy, security, confidentiality, accuracy, human oversight, and acceptable use. Apply thoughtful review and professional judgment when evaluating technology-generated information, ensuring outputs are appropriately validated before being incorporated into medical risk assessments, training resources, business recommendations, processes, or decisions. Demonstrate adaptability and a willingness to learn new tools, systems, and methods, and help translate that knowledge into practical workflows, procedures, reference materials, and training. Identify opportunities for technology to improve efficiency, consistency, documentation, service delivery, and employee or customer experience. Support successful adoption through clear procedures, appropriate safeguards, training, and practical guidance for users.
• Quality Collaboration, System Support, and Projects Partner with management and the designated quality assurance function to understand overall quality trends, recurring knowledge gaps, and potential process risks. Apply validated findings to guide training enhancements and process improvement priorities. Provide structured post-training quality monitoring for up to one year following completion of formal training, with the opportunity to conclude the monitoring period earlier when sustained proficiency has been demonstrated and documented. Ongoing routine quality reviews of established team members beyond this period remain the responsibility of management and the designated quality assurance function. Represent the MRC team in system development, testing, implementation, and enhancement activities, including changes to the ESL claim system. Develop testing scenarios, document outcomes, identify potential defects or workflow impacts, and help confirm operational readiness. Maintain current system procedures, user resources, and training plans to support the MRC team through changes and enhancements. Lead or contribute to cross-functional projects, and prepare and share relevant updates regarding processes, training, production support, and project progress with appropriate stakeholders.
• Professional Development and Collaboration Maintain an active Registered Nurse license, required continuing education hours, and applicable professional certifications in accordance with established renewal requirements. Stay informed of advancements in medical care, emerging treatments, high-cost diagnoses, healthcare utilization, medical cost trends, and developments in Stop Loss insurance that may influence medical risk assessment. Participate in relevant clinical seminars, professional conferences, continuing education, and industry learning opportunities to maintain current medical knowledge and strengthen the application of clinical expertise to underwriting risk evaluation. Share relevant insights with the MRC team and business partners to support informed assessments, effective training, and consistent risk review practices. Foster positive and collaborative working relationships across Medical Risk, Claims, Underwriting, Sales, Technology, and Compliance. Maintain confidentiality and safeguard sensitive information in accordance with applicable legal, regulatory, privacy, security, and company requirements.

Why Work at Symetra

Here’s what some of our employees share about why they choose to work at Symetra:

"If given an opportunity to work for this amazing company-say yes!  You will not be disappointed." - Rebecca A., Sr. Medical Risk Consultant

“If you’re looking for a company that amplifies your talents, values your voice, and encourages continuous growth, Symetra is the place. I feel incredibly lucky to have found this opportunity—and I’ve never been happier in my career!” - Gina B., Medical Risk Manager

What we offer you

Benefits and Perks

We don’t take a “one-size-fits-all” approach when it comes to our employees. Our programs are built to make your life better both at work and at home.

• Flexible full-time or hybrid telecommuting arrangements.
• Plan for your future with our 401(k) plan and take advantage of immediate vesting and company matching up to 6%.
• Paid time away including vacation and sick time, flex days and ten paid holidays.
• Give back to your community and double your impact through our company matching.
• Want more details? Check out our Symetra Benefits Overview.

Compensation

Salary Range: $96,700 - $161,200 plus eligibility for annual bonus program.

Who You Are

• College degree or certification requires.
• RN licensed nurse.
• 5-8 years of cumulative, relevant experience
• Project Management or Process Improvement certification is a plus.