Medical Analyst, LNR/MSA

Company Description

We help the world see new possibilities and inspire change for better tomorrows. Our analytic solutions bridge content, data, and analytics to help business, people, and society become stronger, more resilient, and sustainable.

Job Description

We are seeking Medical Analysts with experience in reviewing medical treatment records related to injury claims. This includes experience in preparing Medicare Set Asides/ Medical Cost Projections, utilization reviews, preparing chronologies, analyzing treatment in medical claims and medical bill reviews. Strong writing skills, analysis skills and application of guidelines are required for this position. Medical Analysts will work closely with our attorneys and other members of the medical team to prepare Legal Nurse Reviews and Medicare Set Asides. Legal Nurse Review duties include preparing chronologies and provide an analysis of treatment/ medical bills for appropriateness under medical guidelines and treatment standards. Medicare Set Aside and Medical Cost Projection duties include application of guidelines in preparing future treatment allocations.

About the Day-to-Day Responsibilities of the Role

•            Review of medical records and injury claim documents to prepare a chronology/ treatment timeline relevant the product and according to provided internal guidelines.

•            Analysis of medical bills and payment histories to determine appropriateness of treatment per guidelines and to project future treatment in allocations.

•            Utilizes provided pricing tools to properly price treatment services based on guidelines.

•            Collaborates with a team of attorneys and medical professionals in identifying mitigating issues for injury claims (both personal injury and workers’ compensation claims.)

•            Uses internal proprietary information technology tools to apply in daily use in preparing reports.

•            Provides additional analysis and medical recommendations as needed.

•            Full-time position, but additional hours may be required during peak time.

•            Requires flexibility to work our various products, including Legal Nurse Reviews and Medicare Set Asides.

•            Occasional travel (<10% of the time)

Qualifications

About You and How You Can Excel in This Role

•            Bachelor’s Degree, Associate Degree or Diploma in Nursing 

•            3-5 years’ experience in Nursing

•            RN license in good standing with the applicable Board of Nursing
Preferred experience in preparing medical chronologies, workers’ compensation claims, personal injury claims, case management in workers’ compensation and/or projecting future treatment in medical cost projections or Medicare Set Asides.  

•            Certification in any of the following preferred: Medicare Set-aside Certified Consultant (MSCC), Life Care Planner (CLCP or CNLCP), Certified Case Manager (CCM), Medical Coding, Legal Nurse Consulting, Rehabilitation Counseling, Disability Management, Utilization Review

•            Strong interpersonal, oral, and written communication skills including report preparation preferred

•            Ability to work effectively both independently and as a member of a team

•            Ability to gather data, compile and synthesize information, including medical information, claims payment histories and billing, to identify level and types of services utilization

Additional Information

In 2022, Verisk received Great Place to Work® Certification for our outstanding workplace culture for the sixth year in a row and second-time certification in the UK, Spain, and India. We’re also one of the 38 companies on the UK’s Best Workplaces™ list and one of 18 companies on Spain’s Best Workplaces™ list.

For over fifty years and through innovation, interpretation, and professional insight, Verisk has replaced uncertainty with precision to unlock opportunities that deliver significant and demonstrable impact. From our historic roots in risk assessment, we’ve grown to provide analytic insights that help transform industries focused on some of the world’s most critical areas. Today, the insurance industry relies on Verisk to be, and to make the world, more productive, resilient, and sustainable.

Verisk works in collaboration with our customers and at the intersection of people, data, and advanced technologies. Through proprietary platformed analytics, advanced modeling, and interpretation, we deliver immediate and sustained value to our customers and through them, to the individuals and societies they serve, with greater speed, precision, and scale.

We’re 9,000 people strong, committed to translating big data into big ideas. We help others see new possibilities and empower certainty into