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The Hanover Insurance Company Sr Medical Claims Consultant in Howell, Michigan

Sr Medical Claims Consultant Howell, MI, USA * Itasca, IL, USA * Richmond, VA, USA * Worcester, MA, USA Req #13727 Tuesday, February 9, 2021For more than 160 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.Our Medical Claims team is currently seeking a Sr. Medical Claims Consultant in in one of the following offices: Worcester, MA, Itasca, IL, Howell, MI or Richmond, VA.This is a Full Time / Exempt position. There is flexibility for substantial remote work once established in the position.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 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 complex medical issues in claims from various lines of business.Responsibilities/Essential Functions:and#8226;Reviews, analyzes, and summarizes medical records and other pertinent documentsand#8226;Researches current literature on medical issues and maintains reference library for adjusters and attorneysand#8226;Provides informed opinion on medical issues relating to causality, accepted standards of care and prognosis of alleged injuries/illnessesand#8226;Prepares exhibits for deposition, trial or mediation including charts, tables, graphs, power point presentationsand#8226;Assists with the location, selection and preparation of medical expert witnesses and consultants and develops and maintains a network of such expertsand#8226;Assists in the development of questioning for cross examination of opposing medical expertsand#8226;Provides individualized training and development to adjusters and/or attorneysand#8226;Attends roundtables, mediations, facilitations, settlement conferences, deposition and trials as requestedand#8226;Participates in special projects as requestedand#8226;Participates actively with various vendors and or business partnersKey Measures of Success:and#8226;Achieve open to closed production expectationsand#8226;Achieve closed referrals expectationsand#8226;Achieve expected roundtable hours per monthand#8226;Reduce and/or avoid costs of IME or record reviews by addressing relevant medical issuesand#8226;Arrange expected training sessionsand#8226;Complete out of office visitsand#8226;Provide research on relevant issues in defense of a claimand#8226;Routinely verify physician credentialsand#8226;Prepare adjusters and/or attorneys for depositions, mediations and trials with attendance as neededand#8226;Provide demonstrative evidence on medical issues such as timelines, graphs, power point presentations when requestedSkills, Key Success Factors and Experience:and#8226;Registered nurse with 5+ years of relevant clinical experience in acute or ambulatory healthcare setting with preferred experience in orthopedics, neurology or neurosurgery.and#8226;Law Degree or commensurate legal experience requiredand#8226;Advanced casualty claim knowledgeand#8226;Knowledge of local and national healthcare information resources and medical expertsand#8226;Knowledge of legal terminology and civil procedureand#8226;Strong inquiry, analytical and technical writing skillsand#8226;Effective interpersonal communication skillsand#8226;Organizational skills with regard to time management, task prioritization, and integration of information from a variety of sourcesand#8226;Fluent in Englishand#8226;Has a clear understanding of the scope of role responsibilities, possesses a high level of technical expertise commensurate with the business needsand#8226;Knowledge of technical materials, rules, procedures or facts required to effectively performing the roleand#8226;Deals with members and co-workers in a tactful, cooperative and helpful manner, reacts pos