DI Benefits Medical Cons

JOB REQUIREMENTS: Primary Duties and Responsibilities Provide technicalmedical expertise and support to the Benefit Claims analysts throughthorough review of claims to include evaluation and analysis of providermedical records, test results and course of treatment. Provide timelyconsultations with the analysts and identify when additional medicalinformation is needed. Clearly communicate the disability claimassessment, rationale and recommendation with medical directors, outsideconsulting physicians and analysts regarding insured's medicalcondition, clinical medical findings, significance of and support forclaimed limitations, appropriateness of treatment and alternatives,expected duration of claim, and potential for rehabilitation or returnto work. Through triaging of disability claim referrals, identify theneed for and coordinate the handling of claim referrals with medicaldirectors and outside consulting physicians. Acts as a liaison for thedivision with all medical resources to ensure that medical reviews arethorough and complete and adhere to the claim philosophy of the BenefitsDivision. Effective medical education and training for new disabilitybenefits analysts. Prepare periodic presentations to the division tohelp ensure efficiency and consistency in administering medical claimprotocols and processes. Participate and at times lead inter and intradepartmental projects and committees Train new DI Benefit MedicalConsultants when required and participate in peer auditing Occasionallypartner with law department to help resolve claim medical disputes vianegotiation and/or participation in litigation. Qualifications A minimumof 5-8 years of professional experience preferably in critical carenursing, medical-surgical nursing or orthopedic nursing with abachelor's degree in nursing A minimum of 5-8 years of professionalexperience as a physician's assistant or nurse practitioner andassociated bachelor/master's degree Consistent critical decision-makingskills and flexibility in all aspects of work 2-3 years of successfulcomplex claims assessment, rationale and recommendations andcommunication with physicians, analysts, lead consultants and teachingat the medical consultant level Ability to consistently assess claimsindependently with consistent high quality audit results in allcategories Strong interest in self-development with demonstratedleadership, engagement, and ability to work independently as well aswith a team Excellent interpersonal skills and proven ability to workeffectively with others at all experience levels Superior written andverbal communication skills. Flexibility and willingness to change asjob duties change Knowledge of computer functions and experience in a

Created: 2026-03-30