Posted Apr 18

Medical File Review Nurse (virtual opportunity)

Zurich North America
United States of America Full Time

Our Medical Review Nurses are experienced in Liability Claims and have the medical case management knowledge and past clinical experience to provide consultative services to our Claims and Staff Legal teams.

In this role, you will use your clinical expertise, nursing judgment and established medical criteria to formulate opinions as to the relatedness of medical conditions. This entails reviewing and analyzing medical records that are provided by a claims professional and/or attorney to compare the documented injury/diagnosis established and treatment rendered.
Additional accountabilities include:

  • Collaborating on liability claims and claims cases that have litigation activity
  • Provide subject matter expertise and partnership as a resource to claims
  • Confirm acceptable standards of medical care by utilizing clinical expertise and professional judgment as supported by established criteria documented in accepted peer reviewed research
  • Provide recommendations for action to the claims adjuster or attorney
  • Document claims file by accurately capturing and updating claims data/information in compliance with best practices.
  • Ensure customer service by proactively communicating information, responding to inquiries, and following customer protocols
  • Maintain professional and technical knowledge by participating in educations opportunities, staying current with industry trends, establishing personal networks, and participating in professional societies
This is a virtual position with a 100% work from home arrangement.

We are open to considering geographic locations but have a preference for Midwest, mid-Atlantic or southeastern United States.

Basic Qualifications:

  • Juris Doctor and 1 or more years of experience in the Managed Care area
  • Bachelor’s Degree and 3 or more years of experience in the Managed Care area
  • Associate’s Degree and 5 or more years of experience in the Managed Care area
  • Licensed RN
  • 5 or more years of clinical experience in medical, surgical, orthopedic, or neurosurgery
  • Certification in Legal Nurse Consulting
Preferred Qualifications:
  • Certified Case Management (CCM), Certified Nurse Life Care Planning (CNLCP)
  • Knowledge of Medicare set asides
  • Knowledge of research criteria for establishing standards of care
  • Ability to collaborate across work groups
  • Customer service experience
  • Ability to effectively present information in written reports to customers
  • Advanced Microsoft Excel and Word skills
  • Ability to multi-task, organize and prioritize
  • Strong verbal and written communication skills, as well as presentation skills
  • Experience in a work environment that required professional and personal effectiveness in establishing relationships with claims partners, peers, and management
Imagine working for a company that truly cares about their employees, customers, stakeholders, and communities they serve.

Imagine working for a values-driven organization that has the ambition and desire to be the best global insurance provider in the world.

Zurich is that place where 55,000 employees across approximately 200 countries and territories are all focused on helping people and helping companies protect what is truly most important to them. We are a values-driven organization that takes pride in the work that we do every day and we have the ambition to be the best global insurer in the world.

EOE disability/vets

Zurich does not accept unsolicited resumes from search firms or employment agencies. Any unsolicited resume will become the property of Zurich American Insurance. If you are a preferred vendor, please use our Recruiting Agency Portal for resume submission.

Primary Location : United States-Virtual-Virtual
Other Locations : United States-Georgia-Virtual, United States-Illinois-Virtual, United States-Illinois-Schaumburg, United States-Florida-Virtual
Schedule : Full-time
Travel : No
Relocation Available : No
Job Posting : 04/07/17
Unposting Date : Ongoing

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