Medical Claim Reviewer Jobs in Romeoville, IL (NOW HIRING)

Who Are We?

Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it.

ClaimCompensation Overview

The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.

Salary Range$262,900.00 - $404,200.001Lead the strategy and operations of Travelers Claim Medical initiatives focusing on how developments in the broader medical environment impact Property & Casualty product lines. This role will serve as a thought leader and help develop the following critical areas for Travelers: Develop strategies and direction to advance Travelers medical capabilities to keep Travelers at the leading edge of the P&C industry. Develop medical management strategies that help injured employees return to work as soon as medically appropriate. Ensure Travelers is prepared to incorporate new and emerging medical technology and practices into its strategies, practices and workflow where appropriate. Conduct research and analysis related to medical and healthcare trends. This includes the physical and psychological influences which can impact claim outcomes. Organize and coordinate Travelers' medical review functions. This includes interpreting Federal and State regulations and medical guidelines to establish medical review policies. Works in close collaboration with the Claim leaders and in partnership with other Medical and Pharmacy professionals.What Will You Do?

• Provide overall program leadership as the organization's lead physician. Serve as the key enabler and facilitator for the Travelers medical strategies and represent the Travelers brand both internally and externally.
• This position will oversee the following key areas:
• Medical Claim Product Research, Strategy and Innovation:
• Design and direct innovative, outcome focused strategies and business plans for medical related product development and enhancements. Strategies may influence design, marketing, best practices, system development, vendor management, policies and procedures and response to legislative and regulatory issues.
• Conduct industry research and analysis related to medical, healthcare and group health trends and practices to keep Travelers at the leading edge of the P&C industry.
• Partner with stakeholders to develop and design projects and proofs of concept to improve business results.
• Stay connected to industry and relevant external bodies/associations to assess trends and coordinate Travelers medical position as appropriate.
• Inform Product and Underwriting insights as appropriate to anticipate, respond to and manage trends.
• Attend external forums representing Travelers. Function as a liaison and professional relations contact on a local and national level.
• May provide input and support medical vendor strategies including vendor selection, negotiation and contracting.
• Medical Direction and Oversight:
• Participate in the design and development of organizational design and workflows that ensure effective implementation of medical strategies.
• Oversee engagement of Regional Medical Directors, Medical Consortiums and other medical resources as appropriate. Train and evaluate physician and non-physician medical review personnel and activities.
• Stay apprised of changes in medical technology and adjust review organizational design and workflows functions accordingly.
• Interpret regulations, statutes and guidelines to establish medical policies as necessary.
• Provide input into the investigation of new technology and the application for improving business process and increasing productivity.
• Claim Practices & Support:
• Provide Medical guidance, support and direction as needed to the Claim Field organization.
• Provide input into to claim practices, marketing strategy and customer services as appropriate to anticipate, respond to and manage medical trends.
• Partner with key stakeholders to assist in the review and monitoring of financial and qualitative operating results related to medical. Share accountability with business partners to achieve and sustain quality results.
• Partner with other medical and pharmacy experts on the development and design of training strategies, programs and curriculum.
• Perform other duties as assigned.

What Will Our Ideal Candidate Have?

• Understanding of healthcare systems including Hospital Services, Pharmacy and Group Health insurance.
• Strong background in Occupational Medicine.
• Background in pain management or orthopedics a plus.
• Understanding of the psychological factors in achieving optimal medical outcomes a plus.
• Experience leading major projects or transformational initiatives from inception through implementation.
• Management experience.
• Proven ability to work in a team environment and collaborate on innovative projects.
• Demonstrated thought leadership.
• Strong research and project management skills.
• Ability to analyze business problems thoughtfully and draw conclusions in uncertain situations.
• Ability to communicate complex issues and connect with all levels of the organization.
• Direct and/or indirect leadership skills.
• Financial management and analysis skills.

What is a Must Have?

• Licensed MD.
• 5 years clinical and utilization management experience.
• Certified by the American Board of Medical Specialties.