Consultant, Claims Casualty

Nationwide•Des Moines, IA

4d•$97,000 - $145,000•Remote

About The Position

Nationwide's Property and Casualty team is seeking individuals passionate about helping people protect what matters most, innovating processes, and providing customer value. This role is within a Fortune 100 company with nearly $70 billion in annual sales. The Medical Cost Containment Consultant is responsible for specialized workers’ compensation bill-review and medical cost-containment work, requiring medical judgment, coding and bill-review expertise, vendor and program knowledge, and close partnership with adjusters and managers. The role involves prioritizing escalated bill reviews, refining rules with bill-review partners, scoping billing issues, supporting adjusters with file reviews and ODG guidance, and developing training. It offers both day-to-day operational support and strategic trend analysis to improve billing accuracy, control medical inflation, and preserve claim quality. The position requires an RN with a coding certificate (preferred for internal applicants, expected within 6 months if not currently a coder). The Consultant role leads projects to achieve business objectives, recommending and implementing policies and procedures, and creating tools to improve customer service, expense management, and workflow. This includes coordinating projects, developing timelines, managing resources, budgeting, and cost containment. The role also involves business process mapping, recommending innovations, managing vendor relationships, serving as a subject matter authority, and overseeing the design and execution of key tools and processes. Responsibilities include responding to management, internal customers, and regulatory agencies on compliance or data matters. The position reports to a Director or Associate Vice President in the Casualty Technical Office and may lead a small team.

Requirements

RN required
Coding certificate required (If an internal applicant, coding certificate is preferred. If not currently a coder, certification would be expected within the first 6 months)
Undergraduate degree in a related field strongly preferred
State licensing where required
Successful completion of required/applicable claims certification training/classes
Seven to 10 years of work experience in claims, preferably in the casualty and litigation area
Management, facilitation, negotiation, delegation and mentoring experience
Knowledge of project management concepts and techniques
Understanding of business terminology, business systems and data processing policies, practices and procedures
Knowledge of business-related systems concepts and requirements
Excellent relationship-building skills
Exceptional project management skills such as organization and planning, interaction, leadership and motivational techniques
Strong negotiation skills and data quality/integrity problem solving skills
Administrative ability to plan, coordinate and assess the work of others, and strong personnel leadership skills in order to train, develop and empower staff
Decision making skills for problem identification and selection of alternatives
Strong verbal and written communication skills to interact with technical personnel and customers
Able to successfully influence and advise senior leaders
Technical report preparation and formal presentation skills
Able to operate effectively within required timelines and handle a significant workload

Nice To Haves

CPCU, AIC or similar professional certifications preferred
Business process mapping experience preferred

Responsibilities

Prioritizing escalated bill reviews in the CEP-Medical queue
Refining Capstone rules with the bill-review partner
Scoping industry billing issues through the Enlyte portal
Supporting adjusters with file reviews, roundtables, and providing ODG guidance
Helping develop training and provide consultative support for the broader team
Coordinating and prioritizing all aspects of projects, including planning, communication, execution and completion
Developing and controlling timelines, including regularly re-assessing risks, throughout project life
Revising project plans on an ongoing basis to maintain alignment with other projects and the business strategy
Responsible for internal and external resource management, budgeting and cost containment
Leading and implementing business process mapping with respect to correcting data quality/integrity issues
Recommending and implementing innovations, tools, products policies and procedures that improve customer service, associate engagement, technical excellence, expense management and workflow and assists in managing these processes
Communicating changes to impacted business units
Providing training to associates and leaders on existing and new processes, products and tools
Serving as the point of contact for associates and leaders on specific products
Ensuring products and tools are meeting associate and member needs
Managing vendor relationships to ensure performance meets or exceeds expectations
Negotiating with large partners/accounts to improve services
Serving as a subject matter authority for the leaders of other departments with issues and innovations
Acting as a liaison with associates to collect and provide feedback and serving as a technical resource
Overseeing design, development and execution of key tools, processes and initiatives and assists in designing training to improve performance and lower loss adjustment expense
Responding to management and internal customers and state insurance departments, statistical bureaus or other regulatory agencies on compliance or data matters
May perform other responsibilities as assigned

Benefits

medical/dental/vision
life insurance
short and long term disability coverage
paid time off with newly hired associates receiving a minimum of 18 days paid time off each full calendar year pro-rated quarterly based on hire date
nine paid holidays
8 hours of Lifetime paid time off
8 hours of Unity Day paid time off
401(k) with company match
company-paid pension plan
business casual attire