Claims - Medical Strategy - Senior Medical Claims Consultant (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 Legal Nurse Consultant in one of the following offices: Worcester, MA or Howell, MI.   

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 one or two days in the office.  There is flexibility for substantial remote work once established in the position. 

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:

The ideal candidate is a Registered Nurse/Attorney who will provide claims adjusters and attorneys with detailed analysis of medical records and other pertinent medical information significant to allegations in liability claims. As a Legal Nurse Consultant, this professional assumes a leadership and SME role on the team and has a skill level to evaluate a variety of complex medical issues in claims from various lines of business including, no-fault, liability, elder care facilities. The Legal Nurse Consultant will be able to independently review records, prepare reports analyzing medical strategy issues, and participate in discussions with adjusters, management, leadership, and attorneys on various strategy issues.

This is a full time / exempt position

 IN THIS ROLE, YOU WILL: 

• Review, analyze, and summarizes medical records and other pertinent documents
• Research current literature on medical issues and maintains reference library for adjusters and attorneys
• Provide informed opinion on medical issues relating to causality, accepted standards of care and prognosis of alleged injuries/illnesses
• Prepare exhibits for deposition, trial or mediation including charts, tables, graphs, power point presentations
• Assist with the location, selection and preparation of medical expert witnesses and consultants and develops and maintains a network of such experts
• Assist in the development of questioning for cross examination of opposing medical experts
• Provide individualized training and development to adjusters and/or attorneys, as needed or requested
• Attend roundtables, mediations, facilitations, settlement conferences, deposition and trials as requested, although most would be virtual only
• Participate in special projects as requested
• Participate actively with various vendors and or business partners
• 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
• Assist with training sessions as requested
• 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 very rarely
• Provide demonstrative evidence on medical issues such as timelines, graphs, power point presentations when requested

WHAT YOU NEED TO APPLY:

• Registered nurse with 5+ years of relevant clinical experience in acute or ambulatory healthcare setting with a preference for orthopedic, neurosurgery, neurology, or elder care facilities. 
• Law Degree, legal nurse consultant degree or certificate, or commensurate legal experience, preferred.
• Deep 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.
• Understanding of the application of the standards of care in evaluating medical strategy issues in claims related to elder care facilities and providers, preferred.
• Advanced casualty claim knowledge
• Knowledge of local and national healthcare information resources and medical experts
• Knowledge of legal terminology and basic litigation processes
• 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
• Deal with members and co-workers in a tactful, cooperative and helpful manner, reacts positively to suggestions or instructions from others
• Understand 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 word processing ability
• 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 occasionally work hours in excess of 40 hours per week
• Ability to work in a fast paced, changing, or stressful environment
• When in the office, ability to perform work in a noisy/loud work environment

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:

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