Clinical Risk Analyst

General Summary

The Clinical Risk Analyst works with the Underwriting Department and an employed physician to evaluate medical records, legal documents, and expert opinions in order to assess potential liability, risk exposure, and financial impact for current and prospective insured physicians. This role also develops data-driven analyses to identify medical and malpractice trends that may impact future risk.

This position offers meaningful opportunities to learn and grow. While prior experience is valued, structured onboarding, ongoing training, and support are provided to help candidates develop the knowledge and skills necessary to succeed.

Essential Duties & Responsibilities

Underwriting Support & Policy Management

• Collaborate with the lead underwriter and underwriting physician to evaluate policy renewals, focusing on high-risk accounts or those with a history of claims
• Develop and maintain underwriting guidelines related to risk assessment for new and renewal business
• Research and prepare files for potential remediation up to non-renewal of an insured’s policy, including physician teleconference meetings
• Attend non-renewal meetings and prepare post-meeting summary analysis for underwriting management
• Assess conditional renewal cases, gathering additional information to determine appropriate policy terms, conditions, and pricing
• Provide data and analysis to support non-renewal decisions, clearly articulating rationale based on risk factors and claims history
• Partner with internal teams to enhance workflows, improve automation, and define monitoring triggers for insured accounts
• Define research projects to generate actionable insights and inform underwriting decisions

Claims Evaluation

• Work with underwriters and claims representatives to review and analyze incoming professional liability claims
• Review medical records, legal documents, and expert opinions to determine liability, risk exposure, and financial impact
• Prepare detailed claims summaries and present findings to underwriting and management

Risk Analysis & Reporting

• Identify trends and patterns in claims data to inform underwriting guidelines and risk mitigation strategies
• Develop and maintain reports on key performance indicators such as claims frequency, severity, and underwriting performance
• Assist in preparing reports for senior management, providing insight into the overall health of the professional liability portfolio
• Perform additional duties as needed

Education & Qualifications

• Demonstrated openness to learning and a growth mindset; training and support are provided
• Degree required in one of the following: physician, physician assistant, nurse practitioner, insurance, risk management, healthcare administration, or nursing
• Advanced clinical degree or Legal Nurse Consultant certification is a plus
• Minimum of 3 years of direct healthcare experience required
• Minimum of 3 years of professional liability insurance experience preferred (claims, underwriting, or related)
• Strong ability to interpret medical and legal documents
• Familiarity with medical terminology and healthcare systems preferred
• Knowledge of state-specific insurance regulations and legal frameworks is a plus
• Strong analytical, problem-solving, and organizational skills
• Excellent written and verbal communication skills with the ability to explain complex information clearly
• Proficiency in Excel and data/reporting tools; programming languages such as R are a plus
• Ability to work independently and collaboratively in a fast-paced environment
• High level of professionalism, confidentiality, and attention to detail