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Claims Risk Manager Jobs in New York (NOW HIRING)

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Manager, Risk Management

Manhattan, NY

$125K - $160K/yr

Responsibilities The Construction Risk Manager will support the Company's risk management programs ... and claims data * Maintain program documentation for Controlled Insurance Programs * Prepare ...

Related

Manager, Risk Management

Manhattan, NY · On-site

$125K - $160K/yr

Responsibilities The Construction Risk Manager will support the Company's risk management programs ... and claims data * Maintain program documentation for Controlled Insurance Programs * Prepare ...

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Claims Associate, Risk Management

Manhattan, NY

$120K - $140K/yr

Minimum 4 years of experience in risk management, insurance claims processing, or a related field. * Solid understanding of insurance policies, claims procedures, and terminology across multiple ...

Related

Claims Associate, Risk Management

Manhattan, NY · On-site

$120K - $140K/yr

Minimum 4 years of experience in risk management, insurance claims processing, or a related field. * Solid understanding of insurance policies, claims procedures, and terminology across multiple ...

TeraWulf Inc.

Risk Insurance Manager

Manhattan, NY · On-site

$80 - $120/hr

This role will be responsible for administering insurance programs, managing claims, and partnering cross-functionally to identify and mitigate risk exposure across development, construction, and ...

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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?

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 New York? For Claims Risk Manager jobs in New York, the most frequently searched job titles are:
What job categories do people searching Claims Risk Manager jobs in New York look for? The top searched job categories for Claims Risk Manager jobs in New York are:
What cities in New York are hiring for Claims Risk Manager jobs? Cities in New York with the most Claims Risk Manager job openings:
Claims Risk Manager jobs near you

Regional Risk Management Manager (Registered Nurse)

EmblemHealth

Manhattan, NY • On-site

Other

Re-posted 29 days ago

EmblemHealth rating

9.4

Company rating: 9.4 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

7th of 304 rated insurance

Job description

AdvantageCare Physicians (ACPNY) is a primary and specialty care practice serving half a million patients across the New York metropolitan area. With more than 30 medical offices across New York City's five boroughs and Long Island, ACPNY is continually expanding our practice and enhancing our services for communities throughout New York. As we grow, our employees grow with us.


Summary of Position

  • Responsible for day-to-day risk prevention and mitigation (clinical and non-clinical), safety, and regulatory/ accreditation compliance in assigned AdvantageCare Physicians (ACPNY) medical offices across Manhattan, Bronx and Queens.
  • Conduct regulatory and compliance reviews to identify potential risk/s. Develop solutions to mitigate and prevent ACPNY medical office risk.
  • Recommend increased efficiency and/or effectiveness of the risk management related control systems, including providing value-added analysis on business operations and integrity of internal controls.


Principal Accountabilities

  • Investigate, track, trend and report safety and incident events; analyze and draft documents for root cause analysis.
  • Coordinate and implement corrective action strategies and initiatives.
  • Investigate patient complaints which involve risk or potential litigation issues; investigate general liability incidents.
  • Assist in mitigation of patient complaints and safety issues.
  • Provide support and incident response when there are concerns involving the quality of care rendered to a patient or general patient safety concern, including facilitating effective communication between the patient/family and other members of the health care team relative to the disclosure of the event.
  • Provide support to a patient or family after an adverse event.
  • Develop, analyze and enforce risk management program plans and risk reduction initiatives, ensuring compliance with risk management standards established by accrediting and regulatory agencies.
  • Enact changes in clinical practice, policy and procedure, and employee/medical staff behavior to preserve ACPNY's assets and quality of care.
  • Conduct Risk Management Assessment Surveys. Provide recommendations for improvement.
  • Analyze, coordinate and implement corrective measures for deficiency findings of regulatory surveys; formulate risk identification, trending, assessment, reduction and remediation strategies; revise and implement policies to ensure compliance with current standards and practice related to risk and safety matters.
  • Foster an awareness of risk management practices and techniques through education and communication among senior management and the governing body, medical staff members, and employees at all levels.
  • Provide staff with guidance and education on risk policies and initiatives; participate in privacy and HIPAA investigations and initiatives.
  • Triage complaints and claims related to professional and general liability.
  • Investigate employee incidents which result in injury; prepare documents for liability insurance carriers regarding claims and potential claims.
  • Report all serious events and potential claims to AVP, Risk Management and P3 Claims Management Committee.
  • Review and provide risk recommendations related to patient care policies, procedures, and forms.
  • Continually monitor program effectiveness and provide Risk Management operational reports.
  • Perform other job-related duties as required.

Qualifications

Education, Training, Licenses, Certifications

  • Bachelor's degree in nursing (RN)
  • Current unencumbered New York State Registered Nurse license
  • Associate in Risk Management (ARM)
  • Certified Professional in Healthcare Risk Management (CPHRM)
  • Certified Professional in Healthcare Quality (CPHQ)


Relevant Work Experience, Knowledge, Skills, and Abilities

  • Minimum of five years' experience practicing as a registered nurse including 3+ years patient safety/ risk management related experience
  • Risk Management experience in a hospital or large healthcare system.
  • Excellent communications skills (verbal, written, presentation, interpersonal) with all types/levels of audiences.
  • Proven ability to present and explain complex information and suggest process improvements to diverse audiences including senior level staff
  • Strong organization, prioritization, analytical, problem identification and solving, negotiation, and decision-making skills.
  • Ability to effectively establish and maintain working relationships with peers, senior leadership, and all levels of the organization, with a positive and professional image.
  • Proficient in use of Microsoft Office products including Excel, Word, PowerPoint, and Visio.
Additional Information
  • Requisition ID: 1000003072
  • Hiring Range: $105,000-$125,000

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