Claims Psychiatric Consultant

Overview

A highly specialized role providing technical psychiatric support to the Claims Department, acting as liaison with physician constituents to evaluate psychiatric aspects of claims, advocate the company’s psychiatric position, resolve disputes, and continually improve protocols for psychiatric claim management.

Responsibilities

• Provide expert psychiatric technical support to ensure timely and consistent review of the psychiatric components of claims through evaluation of medical records, opinions to Claim analysts, and identification of additional information needs (e.g., Attending Physician Statements, treatment records, test results, Evaluative Medical Examination reports, and Paper Review reports).
• Identify the need for and coordinate handling of claim referrals to psychiatric staff or to EME/Paper Review physicians; act as the liaison between the Claims Department and psychiatric resources (psychiatric consultants, EME physicians, and other outside psychiatric experts) to ensure reviews are thorough, complete, and aligned with the Claims Department’s claim philosophy; triage and review all psychiatric cases to determine level of review required.
• Communicate with and advocate the company’s position to attending physicians and insureds regarding the insured’s psychiatric condition, clinical findings, significance of claimed limitations, appropriateness of treatment and alternatives, expected duration of claim, and potential for rehabilitation or return to work; assist the Claims Department in expediting psychiatric reviews and providing expected customer service. Resolve psychiatric disputes through negotiation and/or participation in litigation.
• Research, create, and present psychiatric education and training for the Claims Department; provide new analyst psychiatric training classes and periodic presentations to ensure efficiency and consistency in administering psychiatric claim protocols and processes.

• Minimum of a Master’s Degree in Social Work or Master’s Degree in Psychology;
  Current LCSW or LPC state license.
• Minimum of 5-7 years of clinical mental health experience.
• Excellent interpersonal skills and proven ability to work with others at all experience levels.
• Superior written and verbal communication skills; strong analytical skills and sound judgment/decision-making ability.
• Demonstrated leadership ability; teaching experience in staff development or unit management or equivalent administrative experience.
• Knowledge of disability insurance or prior experience in insurance claim management preferred.
• Knowledge of computer functions and Windows environment.

• Pay Range - Start: $78,190.00
• Pay Range - End: $
• Geographic Specific Pay Structure: $86,030.00 USD - $ USD
• Structure 115: $89,950.00 USD - $ USD

Notes
:
We believe in fairness and transparency regarding salary ranges; final salaries depend on factors including skills and experience, location, and market conditions; geographic-specific pay structures may apply in certain locations.

Equal Opportunity
:
Northwestern Mutual is an equal opportunity employer that welcomes and encourages diversity in the workforce. We are committed to an environment where each employee can contribute ideas, seek challenges, assume leadership, and achieve business and personal objectives.

• Flexible work schedules
• Concierge service
• Comprehensive benefits
• Employee resource groups