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