Consultant, Claims Casualty

About the Role

If you’re passionate about helping people protect what matters most to them at a Fortune 100 company with nearly $70 billion in annual sales, as well as innovating and simplifying processes and operations to provide the best customer value, then Nationwide’s Property and Casualty team could be the place for you! At Nationwide®, “on your side” goes beyond just words. Our customers and partners are at the center of everything we do, and we’re looking for associates who are passionate about delivering extraordinary care.

Responsibilities

As a Medical Cost Containment Consultant, you will be responsible for specialized workers’ compensation bill-review and medical cost-containment work. This role requires medical judgment, coding and bill-review expertise, vendor and program knowledge, and close partnership with adjusters and managers. Key responsibilities include:

• Prioritizing escalated bill reviews in the CEP-Medical queue
• Refining Capstone rules with the bill-review partner
• Scoping industry billing issues through the Enlyte portal
• Supporting adjusters with file reviews, roundtables, and providing ODG guidance
• Helping develop training and providing consultative support for the broader team
• Providing day-to-day operational support and strategic trend analysis to improve billing accuracy, control medical inflation, and preserve claim quality and continuity

Qualifications

• RN required
• Coding certificate required (preferred for internal applicants; certification expected within 6 months if not currently a coder)

Skills

• Strong desire to resolve insurance claims by providing prompt, courteous, and fair service to customers
• Skilled investigator, negotiator, and communicator
• Ability to problem-solve claims resolution while following processes that provide fair resolution, customer satisfaction, and cost management

Additional Responsibilities

• Coordinates and prioritizes all aspects of projects, including planning, communication, execution, and completion
• Develops and controls timelines, regularly re-assessing risks throughout the project life
• Revises project plans to maintain alignment with business strategy
• Manages internal and external resources, budgeting, and cost containment
• Leads business process mapping to correct data quality/integrity issues
• Recommends and implements innovations to improve customer service, associate engagement, technical excellence, expense management, and workflow
• Provides training on existing and new processes, products, and tools
• Manages vendor relationships and negotiates with large partners/accounts
• Serves as a subject matter authority and liaison for associates and leaders
• Oversees design, development, and execution of key tools, processes, and initiatives
• Responds to management, internal customers, and regulatory agencies on compliance or data matters

Experience

• Seven to 10 years of work experience in claims, preferably in casualty and litigation
• Management, facilitation, negotiation, delegation, and mentoring experience
• Business process mapping experience preferred

Education

• Undergraduate degree in a related field strongly preferred
• State licensing where required
• Successful completion of required/applicable claims certification training/classes
• CPCU, AIC, or similar professional certifications preferred

Job Conditions

• Overtime Eligibility: Exempt (Not eligible)
• Working Conditions: Normal office environment with occasional non-standard hours and travel
• Must be willing to work extended hours and travel with possible overnight requirements

Benefits

We offer a comprehensive benefits package, including:

• Medical/dental/vision insurance
• Life insurance
• Short and long-term disability coverage
• Paid time off (minimum of 18 days per year, pro-rated quarterly based on hire date)
• Nine paid holidays
• 8 hours of Lifetime paid time off
• 8 hours of Unity Day paid time off
• 401(k) with company match
• Company-paid pension plan
• Business casual attire

Pay

The expected starting salary range for this position is $97,000.00 - $145,000.00. The national salary range is $97,000.00-$180,000.00. Placement within the range is determined by factors including skills, experience, and location.