Medical Analyst

at

Verisk

North Reading, MA
Full Time
10mo ago

Company Description

ISO Claims Partners, a Verisk business, is a nationally recognized leader in providing cost-effective and proven Medicare compliance and claim analytics services for Workers’ Compensation, First-Party No-Fault, and Liability claims. For the past two decades we have been a trusted consultant and provider to the largest carriers, TPAs, and self-insured Fortune 1000 companies in the world. We draw on unique data assets and deep domain expertise to develop products and services designed with one goal in mind: improving claims outcomes throughout the life of a claim. We accomplish this by providing cutting-edge analytics, unmatched data, and superior medical and legal advocacy – with big payoffs, taking claims organizations from a reactive to a proactive approach. ISO Claims Partners is headquartered in North Reading, Massachusetts, and has offices throughout North America. To learn more about ISO Claims Partners, please visit us at www.verisk.com/claimspartners. We are proud to be a part of the Verisk family of companies! 

At the heart of what we do is help clients manage risk. Verisk (Nasdaq: VRSK) provides data and insights to our customers in insurance, energy and the financial services markets so they can make faster and more informed decisions.   

Our global team uses AI, machine learning, automation, and other emerging technologies to collect and analyze billions of records. We provide advanced decision-support to prevent credit, lending, and cyber risks. In addition, we monitor and advise companies on complex global matters such as climate change, catastrophes, and geopolitical issues.  

But why we do our work is what sets us apart. It stems from a commitment to making the world better, safer and stronger.  

It’s the reason Verisk is part of the UN Global Compact sustainability initiative. It’s why we made a commitment to balancing 100 percent of our carbon emissions. It’s the aim of our “returnship” program for experienced professionals rejoining the workforce after time away. And, it’s what drives our annual Innovation Day, where we identify our next first-to-market innovations to solve our customers’ problems.   

At its core, Verisk uses data to minimize risk and maximize value. But far bigger, is why we do what we do. 

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 fifth 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.  

Job Description

We are seeking Medical Analysts with experience in preparing Medicare Set Asides and Medical Cost Projections. This includes reviewing records, preparing the narrative and an appropriate allocation for medical treatment and prescription medications. Candidates will demonstrate knowledge of CMS policies related to preparing MSAs. 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 Medicare Set-Asides and Medical Cost Projections.

About the Day to Day Responsibilities of the Role

  • Through a review of relevant medical files and related documentation, provides a narrative and cost projection for future treatment related to Workers Compensation and Liability injuries consistent with the current guidelines
  • Collaborates with a team of attorneys and medical professionals in identifying negotiating and documenting guidelines and cost reductions on future treatment plans
  • Uses ISO Claims Partners proprietary information technology tools to identify diagnoses, treatment guidelines, and prescription medication pricing, and documents the case when applicable
  • Provides additional analysis and medical recommendations as needed
  • Identifies cost drivers and cost savings opportunities on all files and completes client specific -cost mitigation activities on files where applicable
  • This is a full-time position, but additional hours may be required during peak time
  • Occasional travel (<10% of the time)

Qualifications

  • Bachelor’s Degree, Associate’s Degree or Diploma in Nursing
  • Registered Nurse (RN) license required in good standing with the applicable Board of Nursing
  • Experience preferred in preparing Medicare Set Asides and future cost projections
  • Certification in any of the following preferred, including but not limited to Medicare Set-Aside Certified Consultant (MSCC), Life Care Planning (CLCP or CNLCP), Certified Case Manager (CCM), Rehabilitation Counseling, Disability Management, Utilization Review, Medical Coding, Legal Nurse Consulting 
  • Strong interpersonal, oral, and written communication skills
  • 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

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.

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