Analyst, Claims-Pet

About the position

Responsibilities

• Processes all new and pending medical claims according to the appropriate workflow.
• Reviews veterinary diagnosis and codes claims according to policy provisions.
• Ensures completion of claims by coding and processing or sending claims to appropriate workflow.
• Determines coverage and approves benefits and eligibility of each claim based on the terms and conditions of the policy.
• Accurately processes claims based on established criteria, provider contract plan and employer group provisions.
• Requests, reviews and evaluates requested medical records or treatment notes for determination of resolving claims.
• Ensures proper documentation in compliance with company policies and practices.
• Records the final disposition of claims, including denial and/or issuing payment.
• Identifies and advises management of questionable claims and questionable risks.
• May perform other responsibilities as assigned.

Requirements

• High school diploma or equivalent; undergraduate degree in biology, zoology or related animal science field preferred.
• State licensing and/or other certification as required; associates must acquire required Federal and/or state licenses/registrations within designated time period.
• Three to five years of veterinary claims experience or equivalent training in a veterinary clinic/hospital position under direct supervision of a veterinarian/veterinary technician preferred.
• Proven understanding of veterinary medical practices and treatment.
• Ability to understand and use Nationwide Insurance policies, riders and endorsements and recognize and resolve questionable coverage situations.
• Ability to read, analyze, and interpret documents.
• Ability to solve practical problems and meet internal customer needs.

Nice-to-haves

• Experience in a veterinary clinic or hospital setting.
• Strong written and verbal communication skills for contact with policyholders, claimants, physicians, medical staff, etc.

Benefits

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