Medical Claims Review RN

Position Title: Medical Claims Review RN – Stop Loss

Location: Lakewood, Ohio


Roundstone is a captive and specialty insurance program manager delivering innovate risk management solutions. When insurance and business advisors need expertise and creative strategies for their clients, they turn to Roundstone. We’re adding to our growing team to help deliver on our motto – Turning Risk into Results.

Roundstone strives to enhance the value our clients experience in our medical expense stop loss program. Continuing with this effort, we have established a dedicated team within our claims department to review large claims. This team will examine medical files and provider bills, ensuring proper coding of procedures, as well as reviewing Reasonable and Customary charges. The team will also negotiate provider reimbursements directly on some claims.

As a Medical Claims Review RN in Roundstone’s medical expense stop loss program, you will work with the claims staff to identify potentially large claims early in the process and use your expertise to manage the medical services. Third party administrators and vendors will work closely with you on a regular basis. This position also works closely with the stop loss underwriters when preparing renewal and potential quotes for cost predictions and cost containment options. Review amendments and inform underwriters if this addition to the plan will have a significant financial impact on the group.

This is a great opportunity for someone with a nursing background to move into the insurance field.

Education and Experience:

  • Minimum RN Associate Degree required; Bachelor Degree in Nursing preferred.
  • Minimum 2 years medical coding, billing negotiation, or nursing experience.
  • Experience reviewing/auditing medical records related to patient treatment, diagnosis, and provider billing to identify any medical and coding discrepancies.

Key Skills: 

  • Ability to recognize potentially catastrophic diagnoses.
  • Strong communicator, particularly in regard to discussing medical conditions with non-professionals.
  • Capable of identifying and completing tasks with minimal direct instruction.
  • Ability to multitask, prioritize, and find creative problem resolutions.

Roundstone offers competitive compensation packages, including full benefits and an industry leading employee profit sharing plan. Click here for more information about Roundstone.

Please send resumes to