Sr Supplier Medical Process Specialist

Zurich North America is seeking an experienced Sr. Supplier Medical Process Specialist to join our team in one of our Managed Care business units across the United States. If you're considering your next career move, Zurich offers you the opportunity to work for a globally recognized company known for its excellent benefits, flexible work arrangements, commitment to work/life balance, and outstanding culture. As a Sr. Supplier Medical Process Specialist, you will manage supplier performance and work product in area(s) of responsibility. Responsible for overall production, quality, and timeliness of supplier. Will handle both complex transactional and procedural issue escalations. Conducts regular quality audits and/or reviews to ensure accuracy and completeness of work performed by supplier. Responsible for participating in continuous process and system enhancements to improve operational efficiencies, quality and/or timeliness. At Zurich North America Claims, we understand the importance of flexibility and work-life balance in your career decisions. This position is fully remote. Our hybrid work model is designed to meet our employees' needs, offering the flexibility to perform individual work remotely while encouraging in-person collaboration and connection when it adds value. While our model allows for significant autonomy, please note that occasional in-office attendance may be required. In this role you will be responsible for:

• Administer, monitor and review process and supplier information for 24/7 Triage, Telemedicine and Alternative Return to Work programs. Includes identifying and escalating any anomalies or discrepancies which may have a financial impact to ensure management has access to up to date and accurate information.
• Undertake investigations and inspections of data, processes and practice in accordance with established sourcing/procurement/vendor management procedures to identify potential or actual compliance issues and recommend appropriate action.
• Independently collate, analyze and report on data using pre-determined tools, methods and formats and make recommendations to ensure vendor or supplier frameworks are managed effectively.
• Assess and evaluate business processes to identify opportunities for improvement both internally and with vendors.
• Analyze operational data, identify trends, and collaborate with the Claims and Admin Support teams to optimize vendor performance to mitigate risks and ensure compliance.
• Conduct regular training sessions and meetings with both vendors and customers to review, provide educational support, review, and drive results.
• Participate in quarterly operational reviews with vendors, prioritizing improvement opportunities and implementing changes to drive positive outcomes.
• Maintain professional expertise by staying current with industry trends and contributing to medical management education.
• Manage data and tracking tools to ensure archives, databases and evidence are maintained in line with key governance controls.

Basic Qualifications:

• Associate degree and 3 or more years of experience in the Nursing area AND
• Licensed registered nurse in state of residence
• 3 or more years of clinical experience
• Experience with Microsoft Office
• Experience leading operational initiatives and/or work streams

Preferred Qualifications:

• Bachelors Degree in nursing and 3 more years of experience in the nursing area
• 3+ years of clinical experience
• Knowledge of Workers Compensation and the insurance industry
• Proficiency in Microsoft Office Suite
• Proven experience in leading operational initiatives or workstreams
• Experience in a transactional, operational or customer service environment
• Quality auditing experience
• Knowledge of the insurance industry and regulatory environment
• Demonstrated ability to collaborate effectively across workgroups and/or organizations
• Experience collaborating across work groups and/or companies
• Ability to travel 5-10%

At Zurich, compensation for roles is influenced by a variety of factors, including but not limited to the specific office location, role, skill set, and level of experience. In compliance with local laws, Zurich commits to providing a fair and reasonable compensation range for each role. The proposed salary range for this position is $64,600.00 - 105,900.00, with short-term incentive bonus eligibility set at 10%.

Zurich maintains a comprehensive employee benefits package for employees as well as eligible dependents and competitive compensation. Zurich in North America is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race/ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.