What are the responsibilities and job description for the Medical Analyst, LNR/MSA position at Verisk?
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 big decisions that impact individuals and societies. And we relentlessly and ethically pursue innovation to help move our customers, and the world, toward better tomorrows.
Everyone at Verisk—from our chief executive officer to our newest employee—is guided by The Verisk Way, to Be Remarkable, Add Value, and Innovate.
• Be Remarkable by doing something better each day in service to our customers and each other
• Add Value by delivering immediate and sustained results that drive positive outcomes
• Innovate by redefining what’s possible, embracing challenges, and pushing boundaries
Verisk Businesses
Underwriting Solutions — provides underwriting and rating solutions for auto and property, general liability, and excess and surplus to assess and price risk with speed and precision
Claims Solutions — supports end-to-end claims handling with analytic and automation tools that streamline workflow, improve claims management, and support better customer experiences
Property Estimating Solutions — offers property estimation software and tools for professionals in estimating all phases of building and repair to make day-to-day workflows the most efficient
Extreme Event Solutions — provides risk modeling solutions to help individuals, businesses, and society become more resilient to extreme events.
Specialty Business Solutions — provides an integrated suite of software for full end-to-end management of insurance and reinsurance business, helping companies manage their businesses through efficiency, flexibility, and data governance
Marketing Solutions — delivers data and insights to improve the reach, timing, relevance, and compliance of every consumer engagement
Life Insurance Solutions – offers end-to-end, data insight-driven core capabilities for carriers, distribution, and direct customers across the entire policy lifecycle of life and annuities for both individual and group.
Verisk Maplecroft — provides intelligence on sustainability, resilience, and ESG, helping people, business, and societies become stronger
At Verisk you can build an exciting career with meaningful work; create positive and lasting impact on business; and find the support, coaching, and training you need to advance your career. We have received the Great Place to Work® Certification for the 7th consecutive year. We’ve been recognized by Forbes as a World’s Best Employer and a Best Employer for Women, testaments to our culture of engagement and the value we place on an inclusive and diverse workforce. Verisk’s Statement on Racial Equity and Diversity supports our commitment to these values and affecting positive and lasting change in the communities where we live and work.
Verisk Analytics is an equal opportunity employer.
All members of the Verisk Analytics family of companies are equal opportunity employers. We consider all qualified applicants for employment without regard to race, religion, color, national origin, citizenship, sex, gender identity and/or expression, sexual orientation, veteran's status, age or disability.
http://www.verisk.com/careers.html
Unsolicited resumes sent to Verisk, including unsolicited resumes sent to a Verisk business mailing address, fax machine or email address, or directly to Verisk employees, will be considered Verisk property. Verisk will NOT pay a fee for any placement resulting from the receipt of an unsolicited resume.
HR CCPA Privacy Notice.pdf
