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Career Field
Claims
Insurance Discipline
All
Relocation Assistance
Not Available
Job Duration
Full Time
Salary Offered
Open
Summary Serve as technical resource to provide proactive medical expertise for claim staff.
Primary Duties and Responsibilities Interpret routine, complex or unique medical information Evaluate medical treatment to determine whether it was/is reasonable, necessary and causally related Discuss medical information with claim handler to assist in developing claim resolution strategy Identify medical trends for use in developing and recommending training programs. Respond to claim requests for training as needed Assist claim handler in projecting medical costs of claims Provide medical expertise by attending mediations, arbitrations, pre-trial conferences, depositions and trials with claim staff Document claim activity involvement in systems Maintain accurate productivity records Perform other duties as assigned
Education/Work Experience Registered Nurse or equivalent as well as appropriate license per state regulation. Certified Legal Nurse Consultant desirable. Strong clinical background Knowledge of jurisdiction-specific medical guidelines desirable Strong knowledge of medical causation and relatedness. Strong knowledge of medical treatment standards of care Strong research and analytical thinking skills Effective time management and organizational skills. Very strong oral and written communication skills Interpersonal skills. Good computer skills to include Microsoft Word, Excel and Outlook
Other Medical/Nursing knowledge File Quality Business knowledge/technology Customer service/communication Relationship management Adaptability and ability to work independently
