DI Benefits Medical Cons

Northwestern Mutual•Remote-Wisconsin, WI

1d•$89,360 - $154,200

About The Position

The DI Benefits Medical Consultant provides technical medical expertise and support to Benefit Claims analysts by reviewing claims, evaluating provider medical records, test results, and treatment courses, and identifying when additional medical information is needed. The consultant communicates claim assessments, rationale, and recommendations to medical directors, outside consulting physicians, and analysts. This includes evaluating an insured’s medical condition and clinical findings, the support for claimed limitations, treatment appropriateness and alternatives, expected claim duration, and potential for rehabilitation or return to work. The role triages disability claim referrals and coordinates reviews with medical directors and outside consulting physicians, serving as a liaison with medical resources to ensure thorough reviews aligned with the Benefits Division’s claim philosophy. The consultant provides medical education and training to new disability benefits analysts, prepares presentations on claim protocols and processes, trains new DI Benefit Medical Consultants when required, and participates in peer auditing. The role also participates in or leads departmental projects and committees and may partner with the law department to resolve medical claim disputes through negotiation or litigation participation.

Requirements

A minimum of 5–8 years of professional experience, preferably in critical care nursing, medical-surgical nursing, or orthopedic nursing, with a bachelor’s degree in nursing; or a minimum of 5–8 years of professional experience as a physician’s assistant or nurse practitioner with an associated bachelor’s or master’s degree.
Consistent critical decision-making skills and flexibility in all aspects of work.
2–3 years of successful complex claims assessment, rationale development, recommendations, communication with physicians, analysts, and lead consultants, and teaching at the medical consultant level.
Ability to assess claims independently with consistently high-quality audit results in all categories.
Strong interest in self-development, demonstrated leadership and engagement, and ability to work independently and as part of a team.
Excellent interpersonal skills and ability to work effectively with people at all experience levels.
Superior written and verbal communication skills.
Flexibility and willingness to adapt as job duties change.
Knowledge of computer functions and experience in a Windows environment.
Demonstrated leadership ability.

Nice To Haves

Experience in orthopedic medicine or physical medicine and rehabilitation.
Knowledge of disability insurance or prior experience in insurance claim management.

Responsibilities

Review disability claims and evaluate provider medical records, test results, and courses of treatment.
Consult with Benefit Claims analysts in a timely manner and identify when additional medical information is needed.
Communicate claim assessments, rationale, and recommendations to medical directors, outside consulting physicians, and analysts.
Assess clinical findings, the support for claimed limitations, treatment appropriateness and alternatives, expected claim duration, and potential for rehabilitation or return to work.
Triage disability claim referrals and coordinate handling with medical directors and outside consulting physicians.
Liaise with medical resources to ensure reviews are thorough, complete, and consistent with the Benefits Division’s claim philosophy.
Educate and train new disability benefits analysts.
Prepare periodic presentations to promote efficiency and consistency in administering medical claim protocols and processes.
Participate in and occasionally lead interdepartmental and intradepartmental projects and committees.
Train new DI Benefit Medical Consultants when required and participate in peer auditing.
Partner occasionally with the law department to help resolve medical claim disputes through negotiation or participation in litigation.