Consultant, Claims Casualty

Nationwide Mutual Insurance•Des Moines, IA

3d•Remote

About The Position

This role is for a Consultant on Nationwide's Property and Casualty team, focusing on claims resolution. The position involves leading projects to achieve business objectives, recommending and implementing policies and procedures, and creating/utilizing tools and innovations to improve customer service, expense management, and workflow. The role requires strong investigative, negotiation, and communication skills, with a focus on providing prompt, courteous, and fair service to customers. It also involves problem-solving claims resolution while adhering to processes for fair resolution, customer satisfaction, and cost management. A specific focus is on medical cost containment within workers' compensation, requiring medical judgment, coding and bill-review expertise, vendor and program knowledge, and collaboration with adjusters and managers. Responsibilities include prioritizing escalated bill reviews, refining rules with bill-review partners, scoping billing issues, supporting adjusters with file reviews and ODG guidance, and developing training. The role aims to improve billing accuracy, control medical inflation, and preserve claim quality and continuity.

Requirements

RN required with 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.
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

Undergraduate degree in a related field strongly preferred.
State licensing where required.
Successful completion of required/applicable claims certification training/classes.
CPCU, AIC or similar professional certifications preferred.
Business process mapping experience preferred.

Responsibilities

Coordinates and prioritizes all aspects of projects, including planning, communication, execution and completion.
Develops and controls timelines, including regularly re-assessing risks, throughout project life.
Revises 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.
Leads and implements business process mapping with respect to correcting data quality/integrity issues.
Recommends and implements innovations, tools, products policies and procedures that improve customer service, associate engagement, technical excellence, expense management and workflow and assists in managing these processes.
Communicates changes to impacted business units.
Provides training to associates and leaders on existing and new processes, products and tools.
Leads as point of contact for associates and leaders on specific products.
Ensures products and tools are meeting associate and member needs.
Manages vendor relationships to ensure performance meets or exceeds expectations.
Negotiates with large partners/accounts to improve services.
Serves as a subject matter authority for the leaders of other departments with issues and innovations.
Acts as a liaison with associates to collect and provide feedback and serves as a technical resource.
Oversees design, development and execution of key tools, processes and initiatives and assists in designing training to improve performance and lower loss adjustment expense.
Responds to management and internal customers and state insurance departments, statistical bureaus or other regulatory agencies on compliance or data matters.
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, providing ODG guidance.
Helping develop training and provide consultative support for the broader team.

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