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Claims Risk Manager Jobs in Iowa (NOW HIRING)

Berkley

Manager, Claims

Urbandale, IA · Hybrid

... Claims Manager , you will oversee a team of claims professionals, ensuring timely, fair, and ... Partner with other company departments, including Underwriting, Risk Services, Finance, and Actuary ...

Berkley

Manager, Claims

Urbandale, IA · Hybrid

... Claims Manager , you will oversee a team of claims professionals, ensuring timely, fair, and ... Partner with other company departments, including Underwriting, Risk Services, Finance, and Actuary ...

Berkley

Manager, Claims

Urbandale, IA · On-site

... Claims Manager , you will oversee a team of claims professionals, ensuring timely, fair, and ... Partner with other company departments, including Underwriting, Risk Services, Finance, and Actuary ...

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Claims Risk Manager information

How does a Claims Risk Manager typically collaborate with other departments to minimize organizational risk?

A Claims Risk Manager works closely with departments such as underwriting, legal, compliance, and operations to identify potential risk exposures and implement effective mitigation strategies. They often participate in cross-functional meetings to review claims trends, share insights, and develop risk management policies. This collaborative approach ensures that the organization proactively addresses risks, maintains regulatory compliance, and continually improves claims processes for better outcomes.

What is the difference between Claims Risk Manager vs Claims Adjuster?

AspectClaims Risk ManagerClaims Adjuster
CredentialsTypically requires a bachelor’s degree in risk management, insurance, or related field; certifications like CPCU or ARM are commonRequires a high school diploma or bachelor’s degree; insurance licenses may be needed depending on state
Work EnvironmentOffice-based, strategic planning, risk assessment, policy developmentField or office-based, investigating claims, assessing damages, negotiating settlements
Industry UsageUsed across insurance companies, risk management firms, and large corporationsPrimarily in insurance companies, adjusting claims for auto, property, or health insurance

The Claims Risk Manager focuses on identifying and mitigating risks related to claims, developing policies, and overseeing risk strategies. In contrast, a Claims Adjuster handles the day-to-day investigation and settlement of individual claims. Both roles are essential in the insurance industry but differ in scope and responsibilities.

What are the key skills and qualifications needed to thrive as a Claims Risk Manager, and why are they important?

To thrive as a Claims Risk Manager, you need expertise in insurance claims processes, risk assessment, and regulatory compliance, typically backed by a bachelor’s degree in a relevant field and experience in claims management. Familiarity with claims management systems, risk modeling software, and certifications such as CPCU (Chartered Property Casualty Underwriter) or ARM (Associate in Risk Management) are often required. Strong analytical thinking, attention to detail, and effective communication skills help you investigate claims and collaborate with stakeholders. These skills enable accurate risk evaluation, minimize losses, and ensure the organization’s compliance and financial stability.

What does a Claims Risk Manager do?

A Claims Risk Manager is responsible for identifying, assessing, and managing risks associated with insurance claims within an organization. They analyze claims data to detect patterns, prevent fraudulent activity, and develop strategies to minimize financial losses. Additionally, they work closely with claims adjusters, legal teams, and other departments to ensure compliance with regulations and to optimize claims processes. Their goal is to protect the company from unnecessary losses while ensuring legitimate claims are handled efficiently.
What are popular job titles related to Claims Risk Manager jobs in Iowa? For Claims Risk Manager jobs in Iowa, the most frequently searched job titles are:
What job categories do people searching Claims Risk Manager jobs in Iowa look for? The top searched job categories for Claims Risk Manager jobs in Iowa are:
What cities in Iowa are hiring for Claims Risk Manager jobs? Cities in Iowa with the most Claims Risk Manager job openings:
Claims Risk Manager jobs near you
Risk Program Manager

Risk Program Manager

UnityPoint Health

Sioux City, IA • On-site

Full-time

Medical, Dental, Retirement, PTO

Posted 16 days ago

UnityPoint Health rating

7.3

Company rating: 7.3 out of 10

Based on 359 frontline employees who took The Breakroom Quiz

305th of 890 rated healthcare providers

Job description

Overview
UnityPoint-St Luke's
Full-Time Days
Monday-Friday
The Risk Management Program Manager will participate in creating an atmosphere that supports and encourages high performance, teamwork and continued dedication toward improved Risk Management throughout UPH. This position will focus on creation and execution of action for key, complex projects within and supporting the Risk Management team. Serves as a resource, liaison and representative of UPH, expanding the capabilities of clinicians, managers, and administrators by providing them with resources to accomplish specific objectives aimed at decreasing risk across the health system, improving patient care processes and protecting the assets of the organization. Responsible for supporting and assisting Associate General Counsel, Director Enterprise Risk Management and Risk Managers to oversee projects and initiatives to ensure timelines and high-quality outcomes are achieved.
Why UnityPoint Health?
At UnityPoint Health, you matter. We're proud to be recognized as a Top 150 Place to Work in Healthcare by Becker's Healthcare several years in a row for our commitment to our team members.
Our competitive Total Rewards program offers benefits options that align with your needs and priorities, no matter what life stage you're in. Here are just a few:
  • Expect paid time off, parental leave, 401K matching and an employee recognition program.
  • Dental and health insurance, paid holidays, short and long-term disability and more. We even offer pet insurance for your four-legged family members.
  • Early access to earned wages with Daily Pay, tuition reimbursement to help further your career and adoption assistance to help you grow your family.

With a collective goal to champion a culture of belonging where everyone feels valued and respected, we honor the ways people are unique and embrace what brings us together.
And, we believe equipping you with support and development opportunities is a vital part of delivering an exceptional employment experience.
Find a fulfilling career and make a difference with UnityPoint Health.
Responsibilities
  • Serves as a risk management advisor and expert; provide justification for decisions using data combined with a deep understanding and knowledge of risk management at UnityPoint.
  • Senior Risk Manager will offer guidance and assist the risk managers and others on several workstreams as well as provide leadership to influence complex risk management decisions.
  • Consult, advise, and lead multiple health system diverse strategic, initiatives, including defining the scope and work plan, managing execution across deliverable design and development, coordinating resources, and aligning with key stakeholders.
  • Assist in the development, implementation, and maintenance of structures and processes which support risk management and patient safety.
  • Provide guidance on risk mitigation strategies, contract formation and contract management.
  • Facilitate the collection, storage, and analysis of loss control, improvement, and safety data.
  • Identify key performance indicators (KPIs) and key risk indicators (KRIs) for data collection, analysis and monitoring of activities to demonstrate reduction in risk and claims for UPH.
  • Report on KPIs, KRIs and other loss control/claims data to UPH leadership on a regular basis.
  • Investigate and develop risk reduction/loss control strategies from claims data.
  • Assist in the development of policies, procedures, systems and works flows that enhance the overall Risk Management Program throughout UPH Health System as appropriate.
  • Initiate planning and development of risk management and loss prevention education for all departments & care providers.
  • Establish and maintain communication between Risk Management and key areas throughout the Market and UPH Health System
  • Utilize all available data sources, identify enterprise-wide loss drivers and develops systems, processes, and practices to improve patient safety and limit liability exposure.
  • Provide risk management consultation and advice to executives, physicians, care providers and employees and maintains knowledge of current healthcare-related risk management trends and issues.
  • Coordinate and/or conduct annual Risk Assessments in high-risk areas or process and implements actions plans from findings.
  • Collaborate with UPH Legal, the Third-Party Administrator, commercial insurance carriers and defense counsel in supporting the litigation process.
  • Complete and report potential liability issues and claims internally as well as to UPH, the Third-Party Administrator, and any other commercial insurers as indicated using claim reporting guidelines established by UPH legal and any commercial insurer as directed.
  • Collaborate with claimants, legal, senior leadership and other colleagues to evaluate and when indicated, negotiate asserted claims to resolution.
  • Inspire, coach and lead team members, fostering individual and team growth through delegation, feedback, instruction, and encouragement building on developing areas of improvement.
  • Assists senior leaders, Directors, Managers and other team members in using the Event Reporting computer system Investigates matters as designated by CEC and/or Risk Management based on severity of event and potential for compensation and/or litigation
  • Lead and organize disclosure teams for adverse outcomes when appropriate for disclosure.
  • Create and disseminate quarterly Risk Analysis and Summary report.
  • Continuously research and find opportunities for advancement of expanding current knowledge for multiple areas of expertise. Position is recognized as a master of the profession.
  • Responsible for working with leadership in the development and execution of operational plans to execute enterprise goals and initiatives.
  • Develop and implement new programs, processes, standards, or operational plans that will impact UnityPoint enterprise wide.
  • Review and make recommendations to continuously improve, expand and create efficiencies in current programs and practices.
  • Synthesize high-level of information into action items, programs, or initiatives.
  • Serves as member of Critical Events Committee (CEC), safety, mortality/morbidity, and other committees that would benefit from risk management representation.
  • Establish and maintain a data gathering and profile analysis for hospital wide risk management activities:
  • Review all Event Reports to screen for potential liability and appropriate follow-up.
  • Provide documentation on Event Reports which require follow-up/action for Risk Management.
  • Works with departments to ensure timely follow-up of Event Reports
  • For any Serious Safety Events and Sentinel Events, lead or contribute to investigation of event (to include staff interviews, review of records for timeline development, verification of policy/procedure compliance or variance). Collaborate with QI Coordinators to organize Root Cause Analysis.
  • Complete medical record reviews, compares current practice against best practice guidelines and provides recommendations to reduce risk and improve patient care processes.
  • Support Patient Relations with Complaint and Grievance responses specific to harm (and potential for liability).
  • Investigate potential compensable events as directed by Director or UPH Legal, which may include interviews of medical staff, employees, visitors, and patients, and assesses potential liability.
  • Identify potential loss conditions and practices and evaluates their significance. Reports findings and devises remedial action plans.
  • Develop and implements loss prevention educational programs and materials.
  • Draft or review documents to reduce institutional exposure to liability.
  • Perform other duties as required or assigned.

Qualifications
Education:
  • Bachelor's degree in nursing, health-related field or risk management required.
  • Master's degree in nursing, healthcare administration, or related field preferred. Juris doctorate may be considered.

Experience:
  • Five (5) years of progressive risk management experience required.
  • Experience in applying modern improvement methodology to lead changes required.
  • Experience in the concepts and applications of continuous improvement including ability to manipulate date, trend and analyze data required.
  • Seven (7) years previous risk management experience required in insurance claims, risk management, customer relations, legal experience, or as a health care provider, or the equivalent combination of education and experience required.
  • Registered Nurse with five (5) years' experience preferred.

License(s)/Certification(s):
  • Certified in one of the following required:
    • Certified Professional in Healthcare Risk Management
    • Associate in Risk Management
    • Certified Professional in Patient Safety
  • Current Nursing license in Iowa, Illinois or Wisconsin preferred.

What UnityPoint Health employees say

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About UnityPoint Health

Sourced by ZipRecruiter

At UnityPoint Health, we provide care in nine regions throughout Illinois, Iowa, and Wisconsin. As the nation's fourth largest nondenominational health system in America, UnityPoint Health keeps people at the center of all we do. We are looking for dynamic and talented individuals to join our team. You'll find opportunities for every sized dream.

Industry

Hospitals

Company size

10,000+ Employees

Headquarters location

West Des Moines, IA, US

Year founded

1995

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