Medical Analyst

4 days ago


Woburn, Massachusetts, United States Verisk Full time
About the Role

We are seeking a skilled Medical Analyst to join our team at Verisk. As a Medical Analyst, you will play a critical role in preparing Medicare Set Asides and Medical Cost Projections for our clients.

Key Responsibilities
  • Review medical records and related documentation to provide a narrative and cost projection for future treatment related to Workers Compensation and Liability injuries.
  • Collaborate with a team of attorneys and medical professionals to identify, negotiate, and document guidelines and cost reductions on future treatment plans.
  • Utilize proprietary information technology tools to identify diagnoses, treatment guidelines, and prescription medication pricing, and document the case when applicable.
  • Provide additional analysis and medical recommendations as needed.
  • Identify cost drivers and cost savings opportunities on all files and complete client-specific cost mitigation activities on files where applicable.
Requirements
  • Bachelor's Degree, Associate Degree, or Diploma in Nursing required.
  • 3-5 years' experience in Nursing preferred.
  • Registered Nurse (RN) license in good standing with applicable Board of Nursing required.
  • Experience in preparing medical review reports, medical bill reviews, and utilization reviews in injury cases preferred.
  • Certification in any of the following preferred: Medicare Set-aside Certified Consultant (MSCC), Life Care Planner (CLCP or CNLCP), Certified Case Manager (CCM), Medical Coding, Legal Nurse Consulting, Rehabilitation Counseling, Disability Management, Utilization Review.
  • Strong interpersonal, oral, and written communication skills, including report preparation preferred.
  • Ability to work effectively both independently and as a member of a team.
  • Ability to gather data, compile, and synthesize information, including medical information, claims payment histories, and billing, to identify level and types of services utilization.
About Verisk

Verisk is a leading data analytics and technology partner to the global insurance industry. We empower communities and businesses to make better decisions on risk, faster. Our team is passionate about using data and technology to drive innovation and improve outcomes. We value learning, caring, and results, and make inclusivity and diversity a top priority.


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