Claims - Medical Strategy - Medical Claims Consultant II (Hybrid)

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, ESG initiatives and IDE journey.

Our medical claims team is currently seeking a Medical Claims Nurse Consultant located near our Itasca, IL office.

At the Hanover we also understand that life and the workplace have changed so we have reimagined the workplace to provide flexible work arrangements that  provide better work life balance.  This position provides a flexible hybrid arrangement, with two days in the office. 

The Hanover is a diverse and inclusive organization focused on hiring the best talent and we encourage all qualified professionals to apply.  We believe that an inclusive, diverse, and equitable workplace make us a better organization and creates a stronger community.

We encourage all qualified nursing professionals to apply! 

Come Discover The Hanover Difference.

POSITION OVERVIEW:
An experienced medical professional responsible for evaluating reasonable, necessary, and related medical diagnoses and treatment against medical treatment guidelines. This position is instrumental in the detailed analysis of medical records, other pertinent medical information, and overall data integrity to support adjusters and attorneys.

This is a full time / exempt position

 IN THIS ROLE, YOU WILL:

• Review and assess information from injured party’s medical records and other pertinent documents to assure the quality, accuracy, and relatedness of the diagnoses, injuries, medical conditions, complications, procedures, prognosis, and treatment contained therein to the alleged accident.
• Review analysis and specific claim case scenarios with adjuster to determine accepted injury specific diagnoses, care, and methods of treatment.  Accurately input and/or modify claims information, including injury specific data, treatment, complications, and prognosis, into the claims systems and databases utilizing ICD-9 and ICD-10 and other applicable standards.
• Collaborate with adjusting staff and Claim leadership in developing resources and work processes.
• Participate in occasional project work.

WHAT YOU NEED TO APPLY:

• Registered Nurse or equivalent health care degree with experience relevant to the medical subject matter, preferably with at least 3 years of clinical experience in areas such as neurology, neurosurgery, orthopedics, or physical medicine. Experience with medical coding and/or billing is a plus.
• Basic understanding of a wide variety of medical diagnoses, treatment, and prognoses that may be relevant to injuries sustained in automobile and non-automobile accidents, as well as, the impact of various complications and co-morbidities.
• Advanced knowledge of medical terminology.
• Must possess organizational skills with regard to time management, task prioritization and integration of information from a variety of sources.  Excellent and proficient data entry skills.
• High level of proficiency in Word, Excel, and use of the Intranet.
• Self-directed and self-motivated.
• Thinks critically and anticipates, recognizes, identifies, and develops solutions to problems in a timely manner. Ability to prioritize among time sensitive assignments and work in a fast-paced environment.
• Possess excellent customer service skills and attitude.

This job posting provides cursory examples of some of the job duties associated with this position.  The examples provided are not complete, and the position may entail other essential and job-related functions and responsibilities that employees will be required to perform. 

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.

Benefits include:

• Medical, dental, vision, life, and disability insurance
• 401K with a company match
• Tuition reimbursement
• PTO
• Company paid holidays
• Flexible work arrangements
• Cultural Awareness Day in support of IDE
• On-site medical/wellness center (Worcester only)
• Click here for the full list of Benefits

EEO statement:

The Hanover values diversity in the workplace and among our customers.  The company provides equal opportunity for employment and promotion to all qualified employees and applicants on the basis of experience, training, education, and ability to do the available work without regard to race, religion, color, age, sex/gender, sexual orientation, national origin, gender identity, disability, marital status, veteran status, genetic information, ancestry or any other status protected by law.  

Furthermore, The Hanover Insurance Group is committed to providing an equal opportunity workplace that is free of discrimination and harassment based on national origin, race, color, religion, gender, ancestry, age, sexual orientation, gender identity, disability, marital status, veteran status, genetic information or any other status protected by law.” 

As an equal opportunity employer, Hanover does not discriminate against qualified individuals with disabilities.  Individuals with disabilities who wish to request a reasonable accommodation to participate in the job application or interview process, or to perform essential job functions, should contact us at: HRServices@hanover.com and include the link of the job posting in which you are interested.

Privacy Policy:

To view our privacy policy and online privacy statement, click here.  

Applicants who are California residents: To see the types of information we may collect from applicants and employees and how we use it, please click here.