DI Benefits Medical Cons

Northwestern Mutual

30d

About The Position

Primary Duties and Responsibilities Provide technical medical expertise and support to the Benefit Claims analysts through thorough review of claims to include evaluation and analysis of provider medical records, test results and course of treatment. Provide timely consultations with the analysts and identify when additional medical information is needed. Clearly communicate the disability claim assessment, rationale and recommendation with medical directors, outside consulting physicians and analysts regarding insured’s medical condition, clinical medical findings, significance of and support for claimed limitations, appropriateness of treatment and alternatives, expected duration of claim, and potential for rehabilitation or return to work. Through triaging of disability claim referrals, identify the need for and coordinate the handling of claim referrals with medical directors and outside consulting physicians. Acts as a liaison for the division with all medical resources to ensure that medical reviews are thorough and complete and adhere to the claim philosophy of the Benefits Division. Effective medical education and training for new disability benefits analysts. Prepare periodic presentations to the division to help ensure efficiency and consistency in administering medical claim protocols and processes. Participate and at times lead inter and intra departmental projects and committees Train new DI Benefit Medical Consultants when required and participate in peer auditing Occasionally partner with law department to help resolve claim medical disputes via negotiation and/or participation in litigation. Qualifications 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 A minimum of 5-8 years of professional experience as a physician’s assistant or nurse practitioner and associated bachelor/master’s degree Consistent critical decision-making skills and flexibility in all aspects of work 2-3 years of successful complex claims assessment, rationale and recommendations and communication with physicians, analysts, lead consultants and teaching at the medical consultant level Ability to consistently assess claims independently with consistent high quality audit results in all categories Strong interest in self-development with demonstrated leadership, engagement, and ability to work independently as well as with a team Excellent interpersonal skills and proven ability to work effectively with others at all experience levels Superior written and verbal communication skills. Flexibility and willingness to change as job duties change Knowledge of computer functions and experience in a “Windows” environment. Experience in orthopedic medicine or physical medicine and rehabilitation Knowledge of disability insurance or prior experience in insurance claim management. Demonstrated leadership ability.

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
A minimum of 5-8 years of professional experience as a physician’s assistant or nurse practitioner and associated bachelor/master’s degree
Consistent critical decision-making skills and flexibility in all aspects of work
2-3 years of successful complex claims assessment, rationale and recommendations and communication with physicians, analysts, lead consultants and teaching at the medical consultant level
Ability to consistently assess claims independently with consistent high quality audit results in all categories
Strong interest in self-development with demonstrated leadership, engagement, and ability to work independently as well as with a team
Excellent interpersonal skills and proven ability to work effectively with others at all experience levels
Superior written and verbal communication skills.
Flexibility and willingness to change as job duties change
Knowledge of computer functions and experience in a “Windows” environment.
Experience in orthopedic medicine or physical medicine and rehabilitation
Knowledge of disability insurance or prior experience in insurance claim management.
Demonstrated leadership ability.

Responsibilities

Provide technical medical expertise and support to the Benefit Claims analysts through thorough review of claims to include evaluation and analysis of provider medical records, test results and course of treatment.
Provide timely consultations with the analysts and identify when additional medical information is needed.
Clearly communicate the disability claim assessment, rationale and recommendation with medical directors, outside consulting physicians and analysts regarding insured’s medical condition, clinical medical findings, significance of and support for claimed limitations, appropriateness of treatment and alternatives, expected duration of claim, and potential for rehabilitation or return to work.
Through triaging of disability claim referrals, identify the need for and coordinate the handling of claim referrals with medical directors and outside consulting physicians.
Acts as a liaison for the division with all medical resources to ensure that medical reviews are thorough and complete and adhere to the claim philosophy of the Benefits Division.
Effective medical education and training for new disability benefits analysts.
Prepare periodic presentations to the division to help ensure efficiency and consistency in administering medical claim protocols and processes.
Participate and at times lead inter and intra departmental projects and committees
Train new DI Benefit Medical Consultants when required and participate in peer auditing
Occasionally partner with law department to help resolve claim medical disputes via negotiation and/or participation in litigation.