Medical Management Analyst

Salary depends on experience
Posted on 11/14/17
Insurance
Salary depends on experience
Posted on 11/14/17

JOB SUMMARY:

Responsible for assisting Claims Department personnel with medical related issues on their claims.

 

ESSENTIAL FUNCTIONS:

At Safety National, we live by the following five core values: Relationships, Integrity, Teamwork, Balance, and Stability. Our Core Values serve as the fundamental foundation of our corporate culture and drive our interactions, both internally and externally. An essential function of all Safety National positions is to fully embrace and represent these core values in our daily work life and relationships.

Responsible for the medical management and oversight of high risk developmental (HRD) and catastrophic claims.

Assist Claims Analysts with medical management issues on assigned claims to include:

Communicate directly with self-administered account or TPA regarding claim medical management status

Direct and advise TPA and Field Nurse Case Manager as to desired claim handling

Document claim file as necessary regarding medical management activity

Refer claims to Best Doctors and other vendor partners for intervention

Travel on an “as needed” basis for TPA, Client and Broker meetings and presentations, seminars and conferences

 

ADDITIONAL RESPONSIBILITIES:

Assist with ongoing training and in-service for Claims Department

Identify opportunities for ongoing training and information for claims team related to medical issues.

Assist as resource for Claims Analysts with medical information

Assist with Best Doctors partnership:

Assist with Best Doctor referral process

Discuss the Best Doctor’s program and benefits to TPA or Self-Administered Adjusters and clients regarding possible referral of a claim.

Participate in Best Doctor’s calls and document in claim file as needed.

Ensure all assigned claims are noted in Best Doctors report log.

Special projects and assistance as required by the Senior Vice President – Claims

QUALIFICATIONS:

Education: RN, BSN

Minimum 10years nursing experience (ER, OR, ICU, or Rehab, etc)

Workers Comp Nurse Case Management experience, minimum 5years.

Excellent written and oral communication skills.

Ability to communicate technical medical information to non-medical audiences.

Computer skills including Microsoft Word, Excel, Outlook and Internet search.

Must be able to think fast, and work in multiple task environment

Highly organized, maintaining large case assignment

Strong sense of customer service.

Professional appearance and attitude

Not the right job?
Join Ladders to find it.
With a free Ladders account, you can find the best jobs for you and be found by over 20,0000 recruiters.