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Carrot Peelers, Sales, Personality and Your Job Search
In-House
Attorney
Health Care
Litigation - Whistleblower - CFTC
Min 5 yrs required
Claims Specialist III, Medical Duties: Provides medical consultation and enrichment to claims managers with emphasis on medical training, litigation support, and injury claim file intervention. Promotes and provides On-Your-Side customer service. Provides medical consultation and enrichment to claims with emphasis on medical training and injury claim file evaluation in accordance with Best Claim Practices. Reports to Reports to Medical Manager. Promptly and effectively handles to conclusion assigned claims with little to no direction and oversight which may include complex and catastrophic casualty losses.Promptly and effectively handles to conclusion all assigned claims with little to no direction and oversight. Makes decisions within delegated authority, recommends settlement values in the disposition of serious and sometimes complex claims as outlined in company policies and procedures. Adheres to high standards of professional conduct consistent with the delivery of superior service. Accurately pays claims based on policy provisions, state mandates and/or fee schedules. Opens, closes and adjusts reserves in accordance with company practices designed to ensure reserve adequacy. Recommends Special Reserves where necessary. Presents medical bill audit expertise and supports third party medical reviews in accordance with corporate and state directives. Serves as a mentor to less experienced claims associates and assists with training/presentations as assigned by claims management. Creates ans analyzes severe incident reports, reinsurance reports and other information to home office, claims management, and underwriting. Partners with SIU and Subrogation to identify fraud and subrogation opportunities. Assists or prepares files for suit, trial, or subrogation. (Property/MD/Casualty). Consults claims staff and defense counsel for discovery processes, suit file/trial strategy as related to case-specific issues. Consults claims staff and defense counsel for discovery processes, suit file/trial strategy as related to case-specific issues. Delivers a positive On-Your-Side customer service experience to all internal, external, current and prospective Nationwide customers.
Qualification and Experience
REQUIREMENTS: Undergraduate degree or equivalent experience preferred. Advanced degrees in law or related discipline desired. Successful completion of required claims certification schools/courses. Professional development such as IIA or CPCU preferred. State licensing where required. 5 years in nursing or medical field. Experience in property and casualty claims or medico-legal field preferred. Prior ADR and litigation experience desired. Broad-based medical knowledge. Knowledge of medical and medico- legal issues pertaining to property and casualty claims processes and practices including common treatment protocols, medical billing practices and bill review, and ADR and litigation processes. Proven ability to meet customer needs and provide exemplary service by informing customers of the claims process and ensuring a positive customer experience. Proven analytical skills necessary to make decisions and resolve conflict in such areas as application of coverage to submitted claims, application of laws of jurisdiction to investigation facts, application of policy exclusions and exceptions. Proven ability to establish repair requirements and cost estimates for extensive material damage losses and serves as a subject matter expert on respective claims projects. Proven organizational skills to effectively prioritize increased and more complex workloads. Demonstrates strong but flexible standards and can act different, can be seen as balanced based on the conflicting demands of the position. Excellent written and verbal communication skills necessary to effectively communicate and/or negotiate with policyholders, claimants, repair persons, attorneys, agents, and general public. Demonstrated leadership capabilities to effectively train, coach, and provide feedback to less experienced associates. Proven ability to operate personal computer with proficient use of claims and business software.
Job ID: 27943
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