[Hiring] Disability Insurance Benefits Medical Consultant @Northwestern Mutual

Role Description

• Provide technical medical expertise and support to the Benefit Claims analysts through thorough review of claims, including 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
  • 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.
• Act 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.
• Provide 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 the 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.

Skills You Have

• Medical Acumen (Expert): Applies knowledge of medical terminology, anatomy, and medical conditions, as well as an understanding of medical treatment options and limitations, to review and analyze medical/claim records.
• Medical Case Consultation (Expert): Applies medical knowledge and clinical experience to provide consultation about a patient's medical condition in relation to benefits and underwriting.
• Decision Making (Expert): Makes timely, data-driven decisions by understanding the probability of success, identifying risks, gathering business requirements, and developing value statements.
• Claims Acumen (Advanced): Applies the knowledge of claims philosophy, contracts, and policies and procedures for filing claims, assessing claims for accuracy and completeness, verifying eligibility, and adjudicating claims based on established criteria.
• Dispute Resolution (Advanced): Resolves conflicts or disagreements between parties using effective communication and negotiation skills.
• Coaching & Mentoring (Advanced): Develops others by providing actionable, constructive feedback through the lens of technical expertise.
• Adaptive Communication (Advanced): Formulates strategies to convey complex information about services, products, systems, or processes to targeted audiences.

Compensation Range

• Pay Range - Start: $89,360.00
• Pay Range - End: $134,040.00
• Geographic Specific Pay Structure:
  • Structure 110: $98,320.00 USD - $147,480.00 USD
  • Structure 115: $102,800.00 USD - $154,200.00 USD
• Final salaries are based on a number of factors, including the skills and experience of the candidate, the current market, location of the candidate, and other factors uncovered in the hiring process.