Clinical Case Manager

18 hours ago


Schaumburg, Illinois, United States Zurich Insurance Group Full time

Zurich Insurance Group is seeking a skilled Clinical Case Manager to join our team in Schaumburg, IL. In this role, you will review highly complex medical bills and reports, including intricate medical jurisdictions, to ensure compliance with regional, national, and local regulations, applicable coding guidelines, and contractual agreements.

Responsibilities:
  • Analyze and resolve complex medical billing disputes by collaborating with corporate law, Technical Claims, and other stakeholders.
  • Participate in medical bill hearings or depositions as required.
  • Validate medical treatments and charges against compensable injuries using medical expertise.
  • Ensure compliance with Best Practices by accurately reviewing medical bills within regulatory timelines.
  • Identify and report suspicious billing activities to the Special Investigations Unit.
Requirements:
  • Bachelor's degree and 2+ years of experience in Critical Care, Emergency Room, Medical-Surgical, or Operating Room settings OR Associate degree and 4+ years of experience in the areas listed above
  • Active Registered Professional Nurse license
  • Customer service experience
  • Knowledge of CPT, ICD-9, ICD-10 codes, and medical terminology

The estimated salary for this position is $93,900 - $155,300 per year, based on location and experience.



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