Sr Medical Claims Consultant

For more than 170 years, The Hanover has been committed to delivering on our promises and being there when it matters the most. We live our values every day, demonstrating we CARE through our values, Sustainability initiatives and inclusive corporate culture.


Our Medical Claims team is currently seeking a Sr. Medical Claims Consultant to join out growing team. This is a Full Time / Exempt role.

POSITION OVERVIEW:
Provides claims adjusters and attorneys with detailed analysis of medical records and other pertinent medical information significant to allegations in liability claims. As a Senior Medical Claims Consultant, this professional assumes a leadership and SME role on the team, and has a skill level to evaluate a variety of medical issues in claims from various lines of business.

Responsibilities/Essential Functions:
• Reviews, analyzes, and summarizes medical records and other pertinent documents
• Researches current literature on medical issues and maintains reference library for adjusters and attorneys
• Provides informed opinion on medical issues relating to causality, accepted standards of care and prognosis of alleged injuries/illnesses
• Prepares exhibits for deposition, trial or mediation including charts, tables, graphs, power point presentations
• Assists with the location, selection and preparation of medical expert witnesses and consultants and develops and maintains a network of such experts
• Assists in the development of questioning for cross examination of opposing medical experts
• Provides individualized training and development to adjusters and/or attorneys
• Attends roundtables, mediations, facilitations, settlement conferences, deposition and trials as requested
• Participates in special projects as requested
• Participates actively with various vendors and or business partners
Key Measures of Success:
• Achieve open to closed production expectations
• Achieve closed referrals expectations
• Achieve expected roundtable hours per month
• Reduce and/or avoid costs of IME or record reviews by addressing relevant medical issues
• Arrange expected training sessions
• Complete out of office visits
• Provide research on relevant issues in defense of a claim
• Routinely verify physician credentials
• Prepare adjusters and/or attorneys for depositions, mediations and trials with attendance as needed
• Provide demonstrative evidence on medical issues such as timelines, graphs, power point presentations when requested

Skills, Key Success Factors and Experience:
• Registered nurse with 5+ years of clinical experience in acute or ambulatory healthcare setting
• Advanced casualty claim knowledge
• Knowledge of local and national healthcare information resources and medical experts
• Knowledge of legal terminology and civil procedure
• Strong inquiry, analytical and technical writing skills
• Effective interpersonal communication skills
• Organizational skills with regard to time management, task prioritization, and integration of information from a variety of sources
• Fluent in English
• Has a clear understanding of the scope of role responsibilities, possesses a high level of technical expertise commensurate with the business needs
• Knowledge of technical materials, rules, procedures or facts required to effectively performing the role
• Deals with members and co-workers in a tactful, cooperative and helpful manner, reacts positively to suggestions or instructions from others
• Understands the potential issues involved in change within the organization and can adjust to the changing work environment
• Proficient using the Internet, Microsoft Office, various vendor software products and have good typing ability

Physical Demands and Work Environment:
• Ability to use a personal computer and other standard office equipment
• Ability to sit and/or stand for extended periods
• Required to work on-site as needed
• Ability to travel as necessary
• Ability to work hours in excess of 40 hours per week
• Ability to work in a fast paced, changing or stressful environment
• Ability to perform work in a noisy/loud work environment


CAREER DEVELOPMENT:
It’s not just a job, it’s a career, and we are here to support you every step of the way. We want you to be successful and fulfilled. Through on-the-job experiences, personalized coaching and our robust learning and development programs, we encourage you – at every level – to grow and develop.

BENEFITS:
We offer comprehensive benefits to help you be healthy, build financial security, and balance work and home life. At The Hanover, you’ll enjoy what you do and have the support you need to succeed.