Zurich NA Medical Professional Case Review Nurse in Sacramento, California
Medical Professional Case Review Nurse
Zurich North America is seeking a Medical Professional Case Review Nurse to support the Major Case Unit in Claims.
To collaborate with Claims to optimize medical mitigation strategies for claims resolution.
Additional responsibilities may include:
• Use clinical expertise, nursing judgment and established medical criteria to formulate opinions as to relatedness of medical conditions by reviewing and analyzing medical records provided by claims professional and/or attorney comparing documented injury/diagnosis established and treatment rendered.
• Document claims file by accurately capturing and updating claims data/information in compliance with best practices.
• Ensure customer service by proactively communicating information, responding to inquiries, and following customer protocols.
• Meet quality standards by following best practices.
• Serve as a technical resource by mentoring new team members and sharing technical knowledge specific to Medical Professional Case Review (MPCR) expertise.
• Follow customer specific handling instructions by reviewing and implementing customer specific processes.
• Protect the Organization´s reputation by keeping claims information confidential.
• Contribute to the team effort by accomplishing related results and participating on projects as needed.
• Maintain professional and technical knowledge by participating in educations opportunities, staying current with industry trends, establishing personal networks, and participating in professional societies.
• Anticipate and respond to inquiries quickly and completely, and provide status updates to ensure customer satisfaction.
• Refer to policies, procedures and specifications to provide technical advice that enables a customer to solve a problem or improve business.
• Bachelor’s Degree and 4 or more years of experience in the Nursing area
• Associate Degree and 6 or more years of experience in the Nursing area
• Licensed RN
• Clinical experience in medical, surgical, orthopedic or neurosurgery
• Experience in Cost Projections or Life Care Planning
• Customer Service experience
• Knowledge of research criteria for establishing standards of care
• Advanced MS Office skills
• Experience collaborating in a team environment, across work groups and ·relationship building
• Experience multi-tasking, adapting to a changing environment, working independently, and coordinating, prioritizing, organizing efficiently
As a condition of employment at Zurich, employees must adhere to our COVID-related health and safety protocols ( https://www.zurichna.com/careers/faq ), including, without limitation, a requirement that employees attest as to their vaccination status with a YES/NO, and upload proof of vaccination status, or negative COVID test results when allowable, to a third-party vendor. These are continuously re-evaluated and the requirements may change at any time.
A future with Zurich
Now is the time to move forward and make a difference. At Zurich, we want you to share your unique perspectives, experiences and ideas so we can grow and drive sustainable change together. As part of a leading global organization, Zurich North America has over 148 years of experience managing risk and supporting resilience. Today, Zurich North America is a leading provider of commercial property-casualty insurance solutions and a wide range of risk management products and services for businesses and individuals. We serve more than 25 industries, from agriculture to technology, and we insure 90% of the Fortune 500®. Our growth strategy is not limited to our business. As an employer, we strive to provide ongoing career development opportunities, and we foster an environment where voices are diverse, behaviors are inclusive, actions drive equity, and our people feel a sense of belonging. Be a part of the next evolution of the insurance industry. Join us in building a brighter future for our colleagues, our customers and the communities we serve. Zurich maintains a comprehensive employee benefits package for employees as well as eligible dependents and competitive compensation. Please click here (https://www.zurichna.com/careers) to learn more.
As a global company, Zurich recognizes the diversity of our workforce as an asset. We recruit talented people from a variety of backgrounds with unique perspectives that are truly welcome here. Taken together, diversity and inclusion bring us closer to our common goal: exceeding our customers’ expectations. Zurich does not discriminate on the basis of age, race, ethnicity, color, religion, sex, sexual orientation, gender expression, national origin, disability, protected veteran status or any other legally protected status. EOE disability/vet
Zurich does not accept unsolicited resumes from search firms or employment agencies. Any unsolicited resume will become the property of Zurich American Insurance. If you are a preferred vendor, please use our Recruiting Agency Portal for resume submission.
Location(s): AM - Remote Work (US)
Remote Working: No
Schedule: Full Time
Linkedin Recruiter Tag: #LI-MM1