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The Senior Nurse Consultant is accountable for reviewing the medical aspects of claim files which are considered complex in nature (e.g. litigated Claims, multiple injuries, traumatic brain and/or spinal damage, etc.) for multiple lines of business and for the development of chronological reports which analyze case files relating to bodily injury, treatment received, and future medical treatments. In addition to composing formal written analyses and conducting file reviews, also generates medical opinions on an informal basis, performs research and provides consultation to the Claims team on medical issues frequently encountered in the Claims review process and provides ongoing education/training to Claims staff on the medical aspects commonly seen in various claims. Additional responsibilities include participating in, as well as leading certain assignments and taking part in project teams within the line of business and at the enterprise level. Projects could include maintaining and updating the SharePoint site, leading or participating in large scale medical training initiatives, piloting new processes, participating in local office efforts such as inclusion or engagement champion, and acting as a medical expert representative on enterprise level project teams. In addition, also acts as a resource to other Nurse Consultants by serving as a mentor and performing onboarding and new hire training.
***The ideal candidate will have previous experience working in a similar role within an insurance carrier or working directly with a law firm. We have multiple location this role can be based from but Los Angeles, CA or Phoenix, AZ are the most ideal. We are open to other location beyond listed cities but the ideal candidate will need to have experience in this arena of a nurse consultant especially with a strong legal background.***
Essential Job Functions
Receives requests from the Claims Adjusters, Farmers Claims handlers, and/or Legal representatives to determine file review needs of complex Claims from various lines of business. This includes addressing medical questions, assessing time sensitive deadline demands by which the requestor may need medical reports, reviewing as well as analyzing medical records and other relevant documents (e.g. deposition transcripts, accident reports, photographs etc.) and conducts necessary research in order to properly assess injuries alleged for each claimant involved. In addition, also completes the review of Claims as it relates to alleged injury, treatment of injury and future treatment to provide claims handler and/or defense attorney with medical analysis/medical explanation of injury. Provides litigation support to Farmers Claims handlers and/or Legal representatives through the review of complex Claims files for multiple lines of business in order to properly assess alleged injuries from claimants involved. This includes, but is not limited to, reviewing disposition transcripts, accident reports and photographs, analyzing expert witness reports and deposition testimony, as well as preparing questions for independent medical examinations. Additional responsibilities include preparing deposition questions for the plaintiff or treating physician, providing discovery and expert retention recommendations to Claims or Legal and attending mediations/depositions for the purpose of being called upon to support Farmers by providing explanations related to medical issues or clarifying medical aspects of the claim file. May also offer medically appropriate suggestions to the claims handler and/or defense attorney in order to obtain additional medical records or to consider obtaining a medical expert. Conducts new hire orientation for recently onboarded Nurse Consultants and assists new employees and peers with report writing, conducting medical analyses and file reviews. Sets priorities and leads projects and/or actively participates on teams relating to various initiatives which includes maintaining and updating the SharePoint site, piloting new processes, leading or participating in a large scale medical training initiative, and acting as an inclusion or engagement champion for the department. May also act as a representative on enterprise level project teams. Develops as well as delivers training and education to Claims professionals via one-on-one, online, or in classroom type settings on various medical topics commonly seen in claims. Examples include traumatic brain injury, spinal injections, soft tissue damage, knee and shoulder injuries. Also researches and monitors developments in the area of medical treatment options and technologies to keep updated on the most current trends and changes. Performs other duties as assigned.
Primarily a sedentary job that may require travel up to 25% of the time and carrying up to 25 lbs.
Required job duties are normally performed in a climate-controlled office environment, but with exposure to some or all of the following environments when in the field: • Uncontrolled outside environmental conditions • Excessive noise levels • Chemicals/biological conditions • Moving mechanical parts • Areas considered dangerous which could affect the respiratory system or skin, such as fumes, odors, dust mists, gases, oils, smoke, soot, or poor ventilation.
High School diploma or equivalent required. Registered Nurse license required. Bachelor of Science in Nursing preferred.
Four years legal nurse consultant experience required. Prior leadership experience and demonstrated project management skills required.
Special Skill Requirement
Legal Nurse Consultant or a Nurse Case Manager certification by a nationally established and accredited testing organization or Juris Doctorate degree preferred. Advanced knowledge of general industry trends relating to the area of liability claims, medical/legal insurance experience preferred, or at least 5 years working within the insurance industry focusing on multiple disciplinary backgrounds like Casualty, Liability, MED/PIP and/or Workers Compensation claims preferred. Excellent written and oral communications skills, including exceptional presentation skills, required along with prior training/mentoring experience. Advanced proficiency with technological equipment and systems needed to complete, monitor, and track work products (e.g. SharePoint and Excel) along with the proven ability/willingness to learn new systems as needed required.
Farmers is an equal opportunity employer, committed to the strength of a diverse workforce. ]]>
Job Posting: 03/20/2020
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